Treatments

How good is your medication? How do we know it works?

Here is a compilation of all the scientific evidence in support of
each of the different treatments for cluster headache. Current
treatments for cluster headache are categorized according to “level of
evidence” the strength of the scientific support for the idea that
they treat cluster headache.

 

Level 1: Randomized clinical trials or meta-analysis of multiple clinical trials with substantial treatment effects

Capsaicin, Civamide, Cocaine, Hyperbaric Oxygen Therapy, Lidocaine, Lithium, Occipital Nerve Block, Octreotide (Sandostatin), Oxygen, Prednisone, Sumatriptan (Imitrex), Verapamil, Zolmitriptan (Zomig)

Level 2: Randomized clinical trials with smaller or less significant treatment effects

Capsaicin, Civamide, Dehydroepiandrosterone (DHEA), Fidelin, Fluasterone, Melatonin, Prastera, Sumatriptan (Imitrex)

Level 3: Prospective, controlled, nonrandomized cohort studies

Capsaicin

Level 4: Historic, nonrandomized cohort or case-control studies

Hypothalamic deep brain stimulation, Methylprednisolone, Sumatriptan (Imitrex), Testosterone, Verapamil, Topiramate (Topamax)

Level 5: Case series, patients compiled in a serial fashion, control group lacking

Baclofen (Kemstro, Lioresal), Capsaicin, Cimetidine (Tagamet), Cocaine, Dihydroergotamine (DHE, Migranal), Eletriptan (Relpax), Frovatriptan (Frova), Gabapentin (Neurontin), Hyperbaric Oxygen Therapy, Hypothalamic deep brain stimulation, Lidocaine, Lithium, Lysergic Acid Diethylamide (LSD, Delysid), Melatonin, Methylergonivine maleate (Methergine), Microvascular decompression, Naratriptan (Amerge), Occipital nerve stimulation (ONS), Occipital Nerve Block, Olanzapine (Zyprexa), Oxygen, Prednisone, Psilocybin, Sphenopalatine Nerve Block, Sumatriptan (Imitrex), Sympathetic Nerve Block, Topiramate (Topamax), Testosterone, Trigeminal Sectioning, Vagus nerve stimulation (VNS), Warfarin (Coumadin, Jantoven, Marevan, Waran), Zolmitriptan (Zomig)

Level 6: Animal studies or mechanical model studies

There are no animal models of cluster headache.

Level 7: Extrapolations from existing data gathered for other purposes, theoretical analyses

No studies apply.

Level 8:Rational conjecture (common sense), common practices accepted before evidence-based guidelines

Ergotamine (Cafergot)