Chronic Cluster Headache with an Atypical Presentation and Treatment Response

Table 1

Summary of treatment options in CH [4–6].

	Medications	Level of evidence	Line	Dosage
Acute treatment	Oxygen	A	First line	100% oxygen 12/15 L/min
	Sumatriptan sc	A	First line	6 mg
	Sumatriptan in	B	First line	20 mg
	Zolmitriptan in	A	First line	5–10 mg
Transitional treatment	Prednisone	C	First line	60–100 mg
	Occipital nerve block	B	First line	Methylprednisolone slow-release, cortivazol (3.75 mg in 1.5 mL saline), plus lidocaine
	Dihydroergotamine	C	Alternative	1 mg sc/im
Prophylactic treatment	Verapamil	B	First line	360 mg/day (240–960)
	Lithium	C	First line	900 mg/day (600–1200)
	Valproic acid	C	Second line	500–2000 mg/day
	Topiramate	B	Second line	50–200 mg/day
	Baclofen	C	Second line	15–30 mg/day
	Melatonin	C	Alternative	10 mg/day

sc: subcutaneous; im: intramuscular; level of evidence: A, data derived from multiple randomized clinical trials or meta-analyses; B, data derived from a single randomized clinical trial or large nonrandomized studies; C, consensus of opinion of the experts and/or small studies, retrospective studies, and registries.