Treatment of Cluster Headache in Episodic Pattern (ICHD-3 3.1.1) with Symptomatic Periods
Clinical scenario
This protocol addresses episodic cluster headache as classified by ICHD-3 criterion 3.1.1 — the predominant pattern of the condition. Patients present with well-defined symptomatic periods lasting from 7 days to several months, most commonly 4–12 weeks, interspersed with symptom-free intervals of at least 3 months. The majority of cluster headache patients follow this episodic course.
Treatment approach
Acute attacks in this setting are managed with specific fast-acting interventions — one injectable and one inhalation-based. The structured protocol defines the preferred first-line approach and the criteria for its application.
Treatment goal: The patient is pain-free or has only mild pain within 15 minutes after treatment.
References
DOI: 10.1111/ene.15956
- the majority of patients experience an episodic pattern (80%, ICHD-3 3.1.1), with symptomatic periods (7 days to several months, most commonly 4–12 weeks) and symptom-free periods of variable duration (minimum of 3 months).
- 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.
- 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.