Editing Cluster headache (section)

==Management==
There are two primary treatments for acute CH: [[oxygen]] and [[triptan]]s,<ref name=AFP2013/> but they are underused due to misdiagnosis of the syndrome.<ref name=Beck/> During bouts of headaches, triggers such as [[alcohol (drug)|alcohol]], [[nitroglycerine]], and naps during the day should be avoided.<ref name=EM2009/>

===Oxygen===
[[Oxygen therapy]] may help to abort attacks, though it does not prevent future episodes.<ref name=AFP2013 /> Typically it is given via a [[non-rebreather mask]] at 12–15 liters per minute for 15–20 minutes.<ref name=AFP2013 /> One review found about 70% of patients improve within 15 minutes.<ref name=EM2009 /> The evidence for effectiveness of 100% oxygen, however, is weak.<ref name="EM2009"/><ref name=pmid26709672>{{cite book |doi=10.1002/14651858.CD005219.pub3 |pmid=26709672 |chapter=Normobaric and hyperbaric oxygen therapy for the treatment and prevention of migraine and cluster headache |title=Cochrane Database of Systematic Reviews |issue=12 |pages=CD005219 |year=2015 |last1=Bennett |first1=Michael H |last2=French |first2=Christopher |last3=Schnabel |first3=Alexander |last4=Wasiak |first4=Jason |last5=Kranke |first5=Peter |last6=Weibel |first6=Stephanie |volume=2016 |pmc=8720466 }}</ref> Hyperbaric oxygen at pressures of ~2 times greater than atmospheric pressure may relieve cluster headaches.<ref name=pmid26709672/>

===Triptans===
The other primarily recommended treatment of acute attacks is subcutaneous or intranasal [[sumatriptan]].<ref name=EFNS/><ref>{{cite web |url=https://www.nlm.nih.gov/medlineplus/ency/article/000786.htm |title=Cluster headache |publisher=MedlinePlus Medical Encyclopedia |date=2012-11-02 |access-date=2014-04-05 |url-status=live |archive-url=https://web.archive.org/web/20140405112718/http://www.nlm.nih.gov/medlineplus/ency/article/000786.htm |archive-date=5 April 2014 }}</ref> Sumatriptan and [[zolmitriptan]] have both been shown to improve symptoms during an attack with sumatriptan being superior.<ref name=Law2013>{{cite book |doi=10.1002/14651858.cd008042.pub3 |chapter=Triptans for acute cluster headache |title=Cochrane Database of Systematic Reviews |issue=4 |pages=CD008042 |year=2013 |last1=Law |first1=Simon |last2=Derry |first2=Sheena |last3=Moore |first3=R Andrew |volume=2018 |pmc=4170909 |pmid=20393964}}</ref> Because of the vasoconstrictive side-effect of triptans, they may be contraindicated in people with [[ischemic heart disease]].<ref name=AFP2013/> The vasoconstrictor [[ergot]] compounds may be useful,<ref name=EM2009/> but have not been well studied in acute attacks.<ref name=Law2013/>

===Opioids===
The use of [[opioid]] medication in management of cluster headache is not recommended<ref name=Pae2008/> and may make headache syndromes worse.<ref>{{cite journal |doi=10.1177/0333102412467512 |pmid=23144180 |title=Medication-overuse headache and opioid-induced hyperalgesia: A review of mechanisms, a neuroimmune hypothesis and a novel approach to treatment |journal=Cephalalgia |volume=33 |issue=1 |pages=52–64 |year=2012 |last1=Johnson |first1=Jacinta L |last2=Hutchinson |first2=Mark R |last3=Williams |first3=Desmond B |last4=Rolan |first4=Paul |s2cid=5697283 |hdl=2440/78280 |hdl-access=free }}</ref><ref>{{cite journal |doi=10.1016/j.tips.2009.08.002 |pmid=19762094 |pmc=2783351 |title=The "Toll" of Opioid-Induced Glial Activation: Improving the Clinical Efficacy of Opioids by Targeting Glia |journal=Trends in Pharmacological Sciences |volume=30 |issue=11 |pages=581–91 |year=2009 |last1=Watkins |first1=Linda R. |last2=Hutchinson |first2=Mark R. |last3=Rice |first3=Kenner C. |last4=Maier |first4=Steven F. }}</ref> Long-term opioid use is associated with well known dependency, addiction, and withdrawal syndromes.<ref>{{cite journal |doi=10.1007/s40263-013-0081-y |pmid=23925669 |title=Medication Overuse Headache: History, Features, Prevention and Management Strategies |journal=CNS Drugs |volume=27 |issue=11 |pages=867–77 |year=2013 |last1=Saper |first1=Joel R. |last2=Da Silva |first2=Arnaldo Neves |s2cid=39617729 }}</ref> Prescription of opioid medication may additionally lead to further delay in differential diagnosis, undertreatment, and mismanagement.<ref name=Pae2008>{{cite journal |doi=10.1007/s11916-008-0023-4 |pmid=18474192 |title=Medication-overuse headache in patients with cluster headache |journal=Current Pain and Headache Reports |volume=12 |issue=2 |pages=122–7 |year=2008 |last1=Paemeleire |first1=Koen |last2=Evers |first2=Stefan |last3=Goadsby |first3=Peter J. |s2cid=28752169 }}</ref>

===Other===
Intranasal [[lidocaine]] (sprayed in the ipsilateral nostril) may be an effective treatment with patient resistant to more conventional treatment.<ref name=CHandM2019/>

[[Octreotide]] administered subcutaneously has been demonstrated to be more effective than placebo for the treatment of acute attacks.<ref>{{cite journal |pmid=21718584 |pmc=2907610 |year=2010 |last1=Matharu |first1=M |title=Cluster headache |journal=BMJ Clinical Evidence |volume=2010 }}</ref>

Sub-occipital steroid injections have shown benefit and are recommended for use as a transitional therapy to provide temporary headache relief as more long term prophylactic therapies are instituted.<ref>{{cite journal |last1=Malu |first1=Omojo Odihi |last2=Bailey |first2=Jonathan |last3=Hawks |first3=Matthew Kendall |title=Cluster Headache: Rapid Evidence Review |journal=American Family Physician |date=January 2022 |volume=105 |issue=1 |pages=24–32 |pmid=35029932 |url=https://www.aafp.org/pubs/afp/issues/2022/0100/p24.html#afp20220100p24-b45 |issn=1532-0650 |access-date=30 October 2022 |archive-date=30 October 2022 |archive-url=https://web.archive.org/web/20221030054813/https://www.aafp.org/pubs/afp/issues/2022/0100/p24.html#afp20220100p24-b45 |url-status=live }}</ref>