Clinical reference · Card 08 of 11 · Guideline
NICE CG150 — cluster headache recommendations
IMAGING
1.3.34Discuss the need for neuroimaging for people with a first bout of cluster headache with a GP with a special interest in headache or a neurologist.
1.3.3Do not refer people diagnosed with cluster headache for neuroimaging solely for reassurance.
ACUTE TREATMENT
1.3.35Offer oxygen and/or a subcutaneous or nasal triptan for the acute treatment of cluster headache.
1.3.36When using oxygen: use 100% oxygen at a flow rate of at least 12 litres per minute with a non-rebreathing mask and a reservoir bag, and arrange provision of home and ambulatory oxygen.
1.3.37Ensure the person is offered an adequate supply of triptans calculated according to their history of cluster bouts, based on the manufacturer’s maximum daily dose.
1.3.38Do not offer paracetamol, NSAIDs, opioids, ergots or oral triptans for the acute treatment of cluster headache.
PROPHYLAXIS AND SPECIALIST ADVICE
1.3.39Consider verapamil for prophylactic treatment during a bout. If unfamiliar with its use for cluster headache, seek specialist advice before starting, including advice on ECG monitoring.
1.3.40Seek specialist advice for cluster headache that does not respond to verapamil.
1.3.41Seek specialist advice if treatment for cluster headache is needed during pregnancy.
OFF-LABEL · UK, JUNE 2025Verapamil for cluster headache; subcutaneous triptans in under-18s; nasal triptans had no UK marketing authorisation for this indication. Prescribe in line with GMC guidance on unlicensed use.
SOURCES NICE CG150 Headaches in over 12s: diagnosis and management. Published September 2012, last updated 3 June 2025. Recommendations 1.3.3, 1.3.34–1.3.41, quoted as published. Off-label notes as stated by NICE, June 2025.
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