Cluster Headache Clinical Practice Guidelines (EAN, 2023)

European Academy of Neurology

These are some of the highlights of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

August 17, 2023

Guidelines for the treatment of cluster headache were published in July 2023 by the European Academy of Neurology (EAN) in the American Journal of Neurology.[1]

For the acute treatment of cluster headache attacks, oxygen (100%) with a flow of at least 12 L/min over 15 min and 6 mg subcutaneous sumatriptan is strongly recommended.

Verapamil at a daily dose of at least 240 mg (maximum dose depends on efficacy and tolerability) is recommended for prophylaxis of cluster headache attacks.

The use of at least 100 mg prednisone (or equivalent corticosteroid) given orally or at up to 500 mg iv per day over 5 days is recommended to reach an effect in cluster headache.

For episodic cluster headache only, lithium, topiramate, and galcanezumab are recommended as alternative treatments.

Greater occipital nerve block is recommended, but electrical stimulation of the greater occipital nerve is not recommended due to the side effect profile.


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