Source.
Department of clinical neurosciences, University of Calgary and
Alberta health services, Calgary, AB, Canada.

Abstract.
Cluster Headaches pain is very intence, usually increases in
intensity very rapidly from onset, and attacks are often frequent
These clinical features result in significant therapeutic challenges. The most effective pharmacological treatment
options for acute CH attack include subcutaneous sumatriptan,
100% oxygen, and intranasal zolmitriptan. subcutaneous or
intramuscular dihydroegotamine and intranasal sumatriptan
are additional options. transitional therapy is applicable
mainly for patients with high frequency (2 attacks per day)
episodic CH, and options include short courses of high-dose
oral corticosteroids, dihydroegotamine, and occipital nerve
blocks with local anesthetic and steroids. prophylactic therapy
is important both for episodic and chronic CH, and the main
options are verapamil and Lithium. Verapamil is a drug of first
choice but may cause cardial arrhythmias, and periodic
electrocardiograms (EKG) during dose escalation are important.
Many other drugs are also in current use, but there is an
insufficient evidence base to recommend them.