Therapy	Dosing	Adverse effects	Comments	Cost*
Oxygen†	100% via nonrebreather face mask at 12 to 15 L per minute for 15 to 20 minutes	None	Not covered by Medicare or Medicaid except for patients enrolled in studies of oxygen use for cluster headache	< $1,000 annually for episodic cluster headache patients < $5,000 annually for chronic cluster headache patients9
Sumatriptan (Imitrex)†	6 mg, subcutaneously; may repeat once at least one hour later 20 mg, nasal spray; maximum of 40 mg per day	Mild to moderate; rarely leads to discontinuation Injections: dizziness, fatigue, injection site reactions, nausea, paresthesia, vomiting Nasal spray: bitter taste	Contraindications include cardiovascular and cerebrovascular disorders and uncontrolled hypertension	Subcutaneous injection: $15 ($200) for one vial (6 mg per 0.5 mL) Nasal spray: $105 ($510) for six 20-mg doses
Zolmitriptan (Zomig)	5 to 10 mg, nasal spray†; may be repeated once after two hours 5 mg, orally; maximum of 10 mg per day	Nasal spray: unpleasant taste, nasal cavity discomfort, somnolence Tablets: asthenia, dizziness, heaviness, nausea, chest tightness, paresthesia	Mild adverse effects in approximately 25% to 33% of patients Effective in episodic cluster headache, not in chronic cluster headache	Nasal spray: Not available ($580) for six 5-mg single-use devices Oral: $10 ($385) for three 5-mg tablets
Corticosteroids	Prednisone: 50 to 80 mg of oral prednisone per day, tapered gradually over 10 to 12 days Methylprednisolone: 100 mg orally, or 500 mg intravenously for five days	Hyperglycemia, hypertension, increased appetite, insomnia, nervousness	May be useful for transitional therapy	Prednisone: $3 for five 50-mg tablets Methylprednisolone: $10 for 100-mg dose (three 32-mg tablets and one 4-mg tablet) $50 for one 500-mg intravenous dose10
Lidocaine	Nasal: 1 mL of 10% solution applied bilaterally with a cotton swab for five minutes	Nasal congestion, unpleasant taste	Some studies recommend application in the ipsilateral nostril 10% lidocaine, which was evaluated in a randomized controlled trial,11 is not readily available in the United States 4% lidocaine nasal spray may be compounded	Not available
Octreotide (Sandostatin)	100 mcg per mL subcutaneously12–14	Bloating, diarrhea, dull background headache, injection site reactions, lethargy, nausea	—	$4 ($35) per dose
Noninvasive vagal nerve stimulation	Transcutaneous stimulation of the vagus nerve in the neck with three consecutive two-minute stimulations for up to four attacks (eight treatments) per day	Site reaction: burning, tingling, soreness, stinging, skin irritation, redness, erythema, facial neurologic reaction (i.e., drooping and twitching), metallic taste	Approved by the U.S. Food and Drug Administration for abortive and preventive treatment of cluster headache	$9,510 annually15