For individuals with cluster headaches, high-flow oxygen was a highly effective treatment with low rates of physical, medical, emotional, and psychological adverse effects. Although triptans were equally effective for treatment of cluster headaches, they had a higher rate of complications, according to a study published in Headache: The Journal of Head and Face Pain.
A team of investigators generated an internet-based survey to determine the efficacy and adverse events associated with treatments for acute cluster headache, including a focus on a subset of patients aged 65 years and older.
Participants from more than 50 countries were invited to complete the Cluster Headache Questionnaire, which included questions about cluster headache diagnostic criteria, efficacy of medications, physical and medical complications, psychological and emotional complications, mood scores, and difficulty obtaining medications. Diagnostic criteria were used to create an independent group with probable cluster headache.
A total of 2193 individuals met the criteria for the study: approximately 73% were categorized with cluster headache and 26% with probable cluster headache. Of the participants with cluster headache, 68.8% were men and 78.0% had episodic cluster headache.
Treatment was reported to be completely or very effective by 54% of participants treated with triptans or oxygen. For those taking dihydroergotamine, cafergot/ergotamine, caffeine and energy drinks, and intranasal ketamine, complete or very effective treatment was reported by 25%, 17%, 17%, and 14%, respectively.
Complete or very effective treatment was reported in 6% of participants taking opioids, in 5% of participants taking intranasal capsaicin, and in 2% of participants using intranasal lidocaine.
No or minimal physical and medical complications and no or minimal psychological and emotional complications were reported by 99% and 97% of participants treated with oxygen. Results were similar for participants treated with intranasal lidocaine (97% and 98%), intranasal ketamine (95% and 98%), intranasal capsaicin (91% and 94%), and caffeine and energy drinks (89% and 91%). With respect to the remaining treatments, no or minimal physical and medical complications and no or minimal psychological and emotional complications were reported by 83% and 89% of participants taking cafergot/ergotamine, by 81% and 91% of participants taking dihydroergotamine, by 76% and 77% of participants taking opioids, and by 73% and 85% of participants taking triptans.
Only 8.7% of participants were 65 years or older, but they reported similar efficacy and adverse events to other participants.
“[T]his study did not include all recommended acute treatments for cluster headache, notably it did not ask about octreotide,” the authors noted.
The concluded, “[O]xygen is reported by survey respondents to be a highly effective treatment with few complications in cluster headache in a large international sample. When choosing among acute treatments, this study suggests that oxygen be considered first-line therapy for cluster headache patients regardless of age, as supported by recent clinical trials and current guidelines.”
Pearson SM, Burish MJ, Shapiro RE, Yan Y, Schor LI. Effectiveness of oxygen and other acute treatments for cluster headache: results from the cluster headache questionnaire, an international survey [published January 11, 2019]. Headache. doi: 10.1111/head.13473