Diagnosis and Treatment of Headache. Cluster Headache Algorithm.

[Return to Diagnosis algorithm]

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Source: Institute for Clinical Systems Improvement (ICSI). Diagnosis and treatment of headache. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2007 Jan. 72 p. Diagnosis and Treatment of Headache Cluster Headache Algorithm Cluster headache The patient would enter this algorithm from box 19 of the Diagnosis Algorithm. A = Annotation Patient meets criteria for cluster headache? A Return to Diagnosis algorithm Is patient currently in a cluster cycle? *Reinforce patient education. *Consider pre-cluster cycle specialty consult. Acute treatment: *Oxygen. *Sumatriptan SQ. *DHE. *Start prophylactic treatment. A Bridging treatment *Corticosteroids. *Ergotamine. *Occipital nerve block. A Maintenance treatment *Verapamil (first-line). *Avoid alcohol consumption during cluster cycle. *Verapamil - high doses. *Steroids and others. *Lithium. *Depakote. *Topiramate. A Therapy successful? *Continue and modify acute treatment. *Continue and modify prophylactic therapy. *Consider referral. Continue therapy through cycle then taper Therapy successful? Consider referral / Out of guideline All copyrights are reserved by the Institute for Clinical Systems Improvement, Inc.