Cluster headache (CH) is a primary
headache (PH) disorder characterized by recurrent attacks of severe/extremely severe unilateral
pain and associated symptoms. While less prevalent than other PHs such as
migraine, CH impact is substantial given the agonizing
pain, negative effect on daily productivity, impaired mental health, and increased costs.
Cluster headache is not optimally treated and few clinical trials are available to model
therapy, especially dosing and administration. Pharmacists are well positioned to help prescribers and CH individuals with several key opportunities. Subcutaneous
sumatriptan (SC SM) lower than the FDA-approved 6 mg per attack, specifically 2 mg and 3 mg, can be considered; literature describes these doses' benefits. Moreover, lower doses may improve patient access to this treatment-of-choice. Despite the SC SM's FDA-approved dose limit of 12 mg per 24 hours, the maximum CH dose has not been examined; this limit merits reevaluation since literature and clinical experience illustrate treatment exceeding this limit.
Oxygen therapy for CH remains unfamiliar to, and under-utilized by, clinicians and CH individuals. Pharmacists can facilitate prescribing, distribution, and administration of
oxygen via education. Patient education for the various CH medication devices, including
oxygen, is paramount.
Narcotics remain widely prescribed for CH, without supporting evidence, but with considerable abuse and diversion risks. Pharmacists are positioned to help guard against
narcotic usage and to direct care toward medications endorsed by CH guidelines. Since the optimal method to initiate and discontinue drugs which may decrease CH attacks' remains unknown, pharmacists can educate clinicians and individuals with CH to make fully informed decisions.