What is the treatment of cluster headache when attacks occur on a daily basis — the chronic form (ICHD-3 3.1.2)?

Cluster headache presenting in its chronic form is defined by a persistent pattern of frequent attacks with minimal or absent remission. This specific presentation requires acute intervention at each attack to achieve rapid pain relief.

Clinical Scenario

Chronic cluster headache (ICHD-3 3.1.2) is characterised by attacks occurring on a daily basis. When symptom-free periods do occur, they last less than 3 months — and this overall pattern must have been present for at least 1 year.

Acute Attack Management

Acute attacks in this chronic daily presentation are addressed with fast-acting injectable and inhalation-based interventions. The structured protocol specifies the preferred options and their parameters — the clinical goal is for the patient to be pain-free or have only mild pain within 15 minutes of treatment.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1111/ene.15956

In patients suffering from the less common chronic presentation (<20% of cluster headaches, ICHD-3 3.1.2), attacks often occur on a daily basis; if symptom-free periods are experienced, these last <3 months, for at least 1 year.
The first option for the treatment of acute attacks of cluster headache should be subcutaneous injection of sumatriptan 6 mg or the inhalation of 100% oxygen with at least 12 L/min over 15 min.
The recommended dosage is inhalation of at least 12 L/min of 100% oxygen (in some cases up to 15 L/min) for a duration of 20 min using a nonrebreather mask; nasal cannulae are not sufficient.
When pooling the 6 mg and 12 mg studies of sumatriptan, 15 min after treatment, 48% of the patients were pain-free and 75% had no pain or mild pain after sumatriptan injection of 6 mg.

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