The revised International Headache Society (IHS) criteria for cluster headache are: attacks of severe or very severe, strictly unilateral pain, which is orbital, supraorbital, or temporal pain, lasting 15 to 180 minutes and occurring from once every other day to eight times daily.
Methods and outcomes
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of interventions to abort cluster headache? What are the effects of interventions to prevent cluster headache? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2009 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations, such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
We found 23 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
In this systematic review, we present information relating to the effectiveness and safety of the following interventions: baclofen (oral); botulinum toxin (intramuscular); capsaicin (intranasal); chlorpromazine; civamide (intranasal); clonidine (transdermal); corticosteroids; ergotamine and dihydroergotamine (oral or intranasal); gabapentin (oral); greater occipital nerve injections (betamethasone plus xylocaine); high-dose and high-flow-rate oxygen; hyperbaric oxygen; leuprolide; lidocaine (intranasal); lithium (oral); melatonin; methysergide (oral); octreotide (subcutaneous); pizotifen (oral); sodium valproate (oral); sumatriptan (oral, subcutaneous, and intranasal); topiramate (oral); tricyclic antidepressants (TCAs); verapamil; and zolmitriptan (oral and intranasal).
The revised International Headache Society (IHS) criteria for cluster headache are: attacks of severe or very severe, strictly unilateral pain, which is orbital, supraorbital, or temporal pain, lasting 15 to 180 minutes and occurring from once every other day to eight times daily. The attacks are associated with one or more of the following, all of which are ipsilateral: conjunctival injection, lacrimation, nasal congestion, rhinorrhoea, forehead and facial sweating, miosis, ptosis, and eyelid oedema. Most people are restless or agitated during an attack. Cluster headache may be episodic or chronic.
Cluster headache is rare, but the exact prevalence remains a matter of debate.
The main focus of intervention is to abort attacks once they have begun and to prevent future attacks.
Sumatriptan, used subcutaneously or intranasally, and zolmitriptan used intranasally reduce the severity and duration of cluster headache attacks once they have begun.
Oral zolmitriptan reduces severity of attacks in people with episodic cluster headache, but we don't know how effective it is in people with chronic cluster headache. We don't know whether oral sumatriptan is effective.
There is consensus that high-dose and high-flow-rate oxygen is effective for abortive treatment of episodic or chronic cluster headache. We don't know whether this consensus can be applied to hyperbaric oxygen, as little research has been conducted.
There is also consensus that subcutaneous octreotide is effective for abortive treatment of cluster headache.
We don't know whether intranasal lidocaine is effective for abortive treatment of cluster headache.
There is consensus that both verapamil and lithium prevent cluster headache, but that verapamil is more effective than lithium, and causes fewer adverse effects.
There is also consensus that corticosteroids and greater occipital nerve injections (betamethasone plus xylocaine) are effective for preventive treatment.
We don't know whether baclofen,
ergotamine or dihydroergotamine,
oral sumatriptan, topiramate, or tricyclic antidepressants are effective for prevention of cluster headache. Some of these interventions are not routinely used in clinical practice.