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Table 13 Levels of recommendation for symptomatic (a) and preventive (b) treatment of cluster headache

From: Italian guidelines for primary headaches: 2012 revised version

Drug

Dosage

Level of recommendation

Comments

 

(a) Symptomatic treatments

 Sumatriptan

6 mg s.c

I

  

 Sumatriptan

20 mg nasal spray

II

It is not approved by regulatory agency for cluster headache in Italy

 

 Zolmitriptan

5–10 mg nasal spray

II

It is approved by regulatory agency for cluster headache in Italy

 

 Oxygen inhalation

6–15 l/min for 15 min

I

  

Drug

Dosage

Level of recommendation

Comments

Episodic

Chronic

(b) Preventive treatments for episodic and chronic cluster headache

 Verapamil

80–120 mg × 3 per day per os

I

IIIa

It is not approved by regulatory agency for cluster headache in Italy

 Prednisone

50–75 mg/day per os for 3–7 days then gradually decreased to stop within 10 days

II

IIIb

It is not approved by regulatory agency for cluster headache in Italy

Repeated use may, over time, induce severe adverse events

 Pizotifen

Start with the dosage of 1 mg/day per os, increase the dosage to a maximum of 2.5 mg, to be reached in 2 weeks

IIIa

 

 Intranasal capsaicin

300 μg/day in the ipsilateral nostril repeatedly to obtain a complete desensitization

IIIa

IIIa

It is not available in Italy

 Methysergide

Start with the dosage of 2 mg/day per os in three administrations, gradually increase the dosage (every 3–7 days) to the dosage of 8 mg/day. Maximum 6 month treatment

IIIb

IIIb

It is not available in Italy

 Histamine sulphate

i.v. diluted in saline or 5 %: 1st day: 2.75 mg in 250 ml, 2nd to 10th day: 11 mg in 500 cc

Starting flow rate of 10 ml/h, then 120 ml/h

IIIa

It is not available in Italy

 Lithium carbonate

300 mg × 3 per day for no more than 22 weeks

IIIb

 
  1. Drugs with levels of recommendation IV include serotonin antagonists, ergotamine derivatives, triptans and melatonin