Editing Cluster headache (section)

==Prevention==
Management for cluster headache is divided into three primary categories: abortive, transitional, and preventive.<ref name=Nal2012>{{cite book|author1=Nalini Vadivelu|author2=Alan David Kaye|author3=Jack M. Berger|title=Essentials of palliative care|publisher=Springer|location=New York, NY|isbn=9781461451648|page=335|url=https://books.google.com/books?id=hGBSe3r_VDUC&pg=PA335|date=2012-11-28|url-status=live|archive-url=https://web.archive.org/web/20170910172156/https://books.google.com/books?id=hGBSe3r_VDUC&pg=PA335|archive-date=10 September 2017}}</ref> Preventive treatments are used to reduce or eliminate cluster headache attacks; they are generally used in combination with abortive and transitional techniques.<ref name=Beck />

===Verapamil===
The recommended first-line preventive therapy is [[verapamil]], a [[calcium channel blocker]].<ref name=AFP2013/><ref name=EFNS>{{cite journal |doi=10.1111/j.1468-1331.2006.01566.x |pmid=16987158 |title=EFNS guidelines on the treatment of cluster headache and other trigeminal-autonomic cephalalgias |journal=European Journal of Neurology |volume=13 |issue=10 |pages=1066–77 |year=2006 |last1=May |first1=A. |last2=Leone |first2=M. |last3=Áfra |first3=J. |last4=Linde |first4=M. |last5=Sándor |first5=P. S. |last6=Evers |first6=S. |last7=Goadsby |first7=P. J. |doi-access=free }}</ref> Verapamil was previously underused in people with cluster headache.<ref name=Beck/>
Improvement can be seen in an average of 1.7 weeks for episodic cluster headache and 5 weeks for chronic cluster headache when using a dosage of ranged between 160 and 720&nbsp;mg (mean 240&nbsp;mg/day).<ref name="vera">{{cite journal |vauthors=Petersen AS, Barloese MC, Snoer A, Soerensen AM, Jensen RH | title =Verapamil and Cluster Headache: Still a Mystery. A Narrative Review of Efficacy, Mechanisms and Perspectives | journal =Headache| date = 2019 | volume =59| issue =8| pages =1198–1211| pmid = 31339562| doi = 10.1111/head.13603| s2cid =198193843 }}</ref> Preventive therapy with verapamil is believed to work because it has an effect on the circadian rhythm and on CGRPs as CGRP-release is controlled by voltage-gated calcium channels.<ref name="vera"/>

===Glucocorticoids===

Since these compounds are [[steroid]]s, there is little evidence to support long-term benefits from [[glucocorticoid]]s,<ref name=AFP2013/> but they may be used until other medications take effect as they appear to be effective at three days.<ref name=AFP2013/> They are generally discontinued after 8–10 days of treatment.<ref name=Beck/> Prednisone is given at a starting dose of 60–80 milligrams daily; then it is reduced by 5 milligrams every day. Corticosteroids are also used to break cycles, especially in chronic patients.<ref name=":1">{{Cite book |last=Butticè |first=Claudio |url=https://www.abc-clio.com/products/a6280c/ |title=What you need to know about headaches |publisher=Greenwood |year=2022 |isbn=978-1-4408-7531-1 |location=Santa Barbara, California |oclc=1259297708 |access-date=19 September 2022 |archive-date=28 November 2022 |archive-url=https://web.archive.org/web/20221128083152/https://www.abc-clio.com/products/a6280c/ |url-status=live }}</ref>

===Surgery===
Nerve stimulators may be an option in the small number of people who do not improve with medications.<ref>{{cite book |doi=10.1159/000323045 |pmid=21422783 |chapter=Peripheral Nerve Stimulation in Chronic Cluster Headache |title=Peripheral Nerve Stimulation |volume=24 |pages=126–32 |series=Progress in Neurological Surgery |year=2011 |last1=Magis |first1=Delphine |last2=Schoenen |first2=Jean |isbn=978-3-8055-9489-9 }}</ref><ref name=EU2013>{{cite journal |doi=10.1186/1129-2377-14-86 |title=Neuromodulation of chronic headaches: Position statement from the European Headache Federation |journal=[[The Journal of Headache and Pain]] |volume=14 |year=2013 |last1=Martelletti |first1=Paolo |last2=Jensen |first2=Rigmor H |last3=Antal |first3=Andrea |last4=Arcioni |first4=Roberto |last5=Brighina |first5=Filippo |last6=De Tommaso |first6=Marina |last7=Franzini |first7=Angelo |last8=Fontaine |first8=Denys |last9=Heiland |first9=Max |last10=Jürgens |first10=Tim P |last11=Leone |first11=Massimo |last12=Magis |first12=Delphine |last13=Paemeleire |first13=Koen |last14=Palmisani |first14=Stefano |last15=Paulus |first15=Walter |last16=May |first16=Arne |issue=1 |page=86 |pmc=4231359 |pmid=24144382 |doi-access=free }}</ref> Two procedures, [[deep brain stimulation]] or [[occipital nerve stimulation]], may be useful;<ref name=AFP2013/> early experience shows a benefit in about 60% of cases.<ref>{{cite journal |doi=10.1097/wco.0b013e32832ae61e |pmid=19434793 |title=Neurostimulation approaches to primary headache disorders |journal=Current Opinion in Neurology |volume=22 |issue=3 |pages=262–8 |year=2009 |last1=Bartsch |first1=Thorsten |last2=Paemeleire |first2=Koen |last3=Goadsby |first3=Peter J |s2cid=2063863 }}</ref> It typically takes weeks or months for this benefit to appear.<ref name=EU2013/> A non-invasive method using [[transcutaneous electrical nerve stimulation]] (TENS) is being studied.<ref name=EU2013/>

A number of surgical procedures, such as a [[rhizotomy]] or [[microvascular decompression]], may also be considered,<ref name=EU2013/> but evidence to support them is limited and there are cases of people whose symptoms worsen after these procedures.<ref name=EU2013/>

===Other===
[[Lithium (medication)|Lithium]], [[methysergide]], and [[topiramate]] are recommended alternative treatments,<ref name=EFNS/><ref>{{cite journal |doi=10.1517/14656566.2010.496454 |pmid=20569084 |title=Pharmacotherapy of cluster headache |journal=Expert Opinion on Pharmacotherapy |volume=11 |issue=13 |pages=2121–7 |year=2010 |last1=Evers |first1=Stefan |s2cid=40081324 }}</ref> although there is little evidence supporting the use of topiramate or methysergide.<ref name=AFP2013/><ref name=CE2010>{{cite journal|author=Matharu M|title=Cluster headache|journal=Clinical Evidence|date=9 February 2010|volume=2010|pmid=21718584|type= Review|pmc=2907610}}</ref> This is also true for [[tianeptine]], [[melatonin]], and [[ergotamine]].<ref name=AFP2013/> [[Valproate]], [[sumatriptan]], and [[oxygen]] are not recommended as preventive measures.<ref name=AFP2013/> [[Botulinum toxin]] injections have shown limited success.<ref>{{cite journal |doi=10.1007/s11916-009-0028-7 |pmid=19272284 |title=The role of nerve blocks and botulinum toxin injections in the management of cluster headaches |journal=Current Pain and Headache Reports |volume=13 |issue=2 |pages=164–7 |year=2009 |last1=Ailani |first1=Jessica |last2=Young |first2=William B. |s2cid=10284630 }}</ref> Evidence for [[baclofen]], [[botulinum toxin]], and [[capsaicin]] is unclear.<ref name=CE2010/>