Dawaa Reference

Clinical reference

Cluster headache (acute attack & prophylaxis)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources5 sources

NICE Guideline CG150 · Egyptian National Drug Formulary - Nervous System Disorders 2025 · Egyptian National Drug Formulary - Cardiovascular 2024 (verapamil monograph) · Sumatriptan 6 mg/0.5 mL solution for injection SmPC sections 4.2-4.3 (eMC product 607) · Cluster Headache - StatPearls - NCBI Bookshelf (NBK544241) - the disease article carries both the indication and this dose

Verified against4 documents
  • Sumatriptan 6 mg/0.5 mL solution for injection SmPC sections 4.2-4.3 (eMC product 607)
  • NICE Guideline CG150
  • Egyptian National Drug Formulary - Cardiovascular 2024 (verapamil monograph)
  • Cluster Headache - disease-level clinical article (cluster-headache-full.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (7)

  • Attacks cause severe, sudden one-sided pain around or above the eye, rated ten out of ten
  • Light and sound sensitivity, when present, tend to affect only the painful side, unlike the bilateral pattern seen in migraine
  • Attacks last 15 minutes to 3 hours and can recur up to eight times a day, most often at night
  • Up to a third of patients develop general skin sensitivity, more common in women and those with recent attacks or comorbid depression [low mood]
  • Suicidal thoughts can accompany attacks, though completed suicide is rare [suicidal thoughts]
  • Bouts over weeks to months alternate with remissions of months to years; a full year without remission defines the chronic form
  • Alcohol, hot weather, stress, nitroglycerin, sexual activity, and glare are described as possible triggers

Signs — what you find (5)

  • Eye redness or tearing on the same side as the pain occurs in about 90% of attacks [eye discharge · eye redness]
  • A blocked or runny nose on the affected side is seen in roughly 84% of attacks [blocked nose · runny nose]
  • Eyelid or facial swelling occurs in about 59% of attacks [eyelid swelling · facial swelling]
  • A constricted pupil or drooping eyelid can appear on the side of the headache [headache · ptosis · small pupil]
  • Patients are agitated and restless during attacks, pacing or rocking rather than lying still as migraine sufferers do [irritability]

Tests (3)

  • A questionnaire on attack duration under 180 minutes plus autonomic features has about 81% sensitivity and 100% specificity
  • Formal diagnosis requires at least five qualifying attacks
  • MRI, or contrast CT as an alternative, is used to exclude a structural or pituitary cause such as a prolactin-secreting tumor

If not this — what else fits (7)

  • Paroxysmal hemicrania lasts only 2 to 30 minutes and responds to indomethacin
  • SUNCT lasts only 5 to 240 seconds, can recur up to 200 times a day, and usually resists treatment
  • Tension headache is bilateral, a dull or squeezing ache linked to fatigue and tender pericranial muscles
  • Trigeminal neuralgia is a brief electrical or stabbing pain in the trigeminal distribution lasting only seconds
  • Primary stabbing headache causes brief stabs of 1 to 10 seconds without autonomic features
  • Migraine is typically a one-sided throbbing headache with the patient lying still in a dark room, and up to half of patients also have bilateral autonomic symptoms, making it the condition most often confused with cluster headache
  • Structural lesions such as carotid artery dissection, intracranial aneurysm, a pituitary tumor, or nasopharyngeal carcinoma can also mimic these headache attacks

SourceStatPearls "Cluster Headache" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Acute attack | Prevention | Main treatment | Transitional prevention - covers the weeks before verapamil works

ACUTE ATTACK - choose one

1

SUMATRIPTAN

Acute attack

1st line

Strength6 mg

Forminjection

Adult dose and duration

6 mg subcutaneously at onset of attack; max 12 mg in 24 hours (minimum 1 hour between doses) - acute attack

Paediatric dose

Not recommended in children under 18 years for cluster headache

Choice

Alternatives for aborting the attack. High-flow oxygen is co-equal on the evidence and the entry keeps it, but no oxygen product appears in the Egyptian register, so it cannot be what a prescription names.

Dose source

Sumatriptan 6 mg/0.5 mL solution for injection SmPC sections 4.2-4.3 (eMC product 607)

Why

Triptan (serotonin receptor agonist) used to abort an acute cluster headache attack by constricting cranial blood vessels and inhibiting release of vasoactive neuropeptides.

Cautions
  • Contraindicated in ischemic heart disease, previous MI, or uncontrolled hypertension.
  • Do not use within 24 hours of ergotamine derivatives.
  • Transient chest tightness or tingling sensations may occur.
  • If the first injection does not touch the attack, a second will not either - do not repeat within the same attack. The second 6 mg is for the next attack, an hour or more later.
  • Barred by ischaemic heart disease, a previous infarct, Prinzmetal's angina, any stroke or TIA, and moderate or severe hypertension - or mild hypertension that is not controlled.
  • Never with ergotamine, another triptan, or an MAOI.
Egyptian brands
Egyptian brandManufacturerIndicative price
SUMIGRAN 6MG/0.5 ML PREFILLED SYRINGESIGMA TEC30.00 EGP
SUMAGRAINE 6MG AMP.UP PHARMA40.00 EGP
2

OXYGEN

Acute attack

1st line

Formnasal

Adult dose and duration

100% Oxygen at 12-15 L/min via non-rebreather mask with reservoir bag for 15-20 minutes - acute attack

Paediatric dose

Specialist pediatric neurology guidance required

Dose source

NICE Guideline CG150

Why

First-line acute abortive therapy co-equal with triptans; essential primary option when triptans are contraindicated or unavailable.

Cautions
  • Must be delivered via high-flow non-rebreather mask with reservoir bag at 12-15 L/min (standard nasal cannula or low-flow concentrators <=5 L/min are ineffective).
  • Caution in severe COPD or hypercapnic respiratory failure.
  • In Egyptian primary care, high-flow oxygen is available in clinic/ER settings for acute attacks; for home use, patients require high-flow cylinder setups as standard home oxygen concentrators (5 L/min) are insufficient.
Egyptian brands

No Egyptian brand matched — prescribe by generic name.

PREVENTION

3

VERAPAMIL

Prevention

1st line

Strength80 mg

Formoral.solid

Adult dose and duration

80 mg 3 times daily, titrate by 80 mg every 3-14 days up to 240-480 mg daily in divided doses - prophylaxis (during cluster bout)

Paediatric dose

Not indicated for cluster headache prophylaxis in children

Dose source

Egyptian National Drug Formulary - Cardiovascular 2024 (verapamil monograph)

Why

Calcium channel blocker used for cluster headache prevention rather than for aborting an attack already under way; it is the standard preventive choice, taken through a cluster period to reduce how often attacks occur.

Cautions
  • A baseline ECG is required before starting and with each dose increase (risk of heart block and bradycardia).
  • Contraindicated in second/third-degree AV block, severe bradycardia, or heart failure.
  • Constipation and peripheral edema are common.
Egyptian brands
Egyptian brandManufacturerIndicative price
VERPAMIL 80MG 20 F.C.TAB.EL NASR7.00 EGP (0.35/unit)
VERATENS 80MG 10 F.C. TAB.PHAROPHARMA4.75 EGP (0.47/unit)
IZOPTOMIL 80 MG 20 TAB.ARAB DRUG COMPANY (ADCO)10.00 EGP (0.50/unit)
ISOPTIN 80 MG 30 F.C. TABS.KAHIRA > ABBOTT LABORATORIES50.00 EGP (1.67/unit)

MAIN TREATMENT

4

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

Cluster Headache - disease-level clinical article (cluster-headache-full.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions
  • RED FLAG - Neuroimaging (MRI or CT with contrast) is needed to rule out structural and pituitary lesions.

TRANSITIONAL PREVENTION - COVERS THE WEEKS BEFORE VERAPAMIL WORKS - give alongside

5

PREDNISONE

Transitional prevention - covers the weeks before verapamil works

add-on - not a substitute

Strength5 mg

Formoral.solid

Adult dose and duration

60 to 100 mg once a day for at least five days, then step the dose down by 10 mg each day until it is stopped. - At least five days at the full dose, then a taper of 10 mg a day - a short course only

Paediatric dose

No paediatric dose in the sources opened - cluster headache in a child belongs with a neurologist.

Dose source

Cluster Headache - StatPearls - NCBI Bookshelf (NBK544241) - the disease article carries both the indication and this dose

Why

Verapamil takes weeks to work, and the article recommends a steroid to cover that gap during a short cluster period. It is a bridge, not a long-term preventive, and it is the one thing that shortens a bout while the real preventive is being titrated.

Cautions
  • This is a short bridging course only; the article warns that steroids are not prescribed for an extended period because of their long-term harms.
  • It raises blood sugar and blood pressure and holds on to salt and water - check both, and take care in a diabetic or hypertensive patient.
  • It masks and worsens infection, and can reactivate a latent one such as tuberculosis.
  • Mood swings, insomnia and, rarely, psychosis can appear at these doses; warn the patient and the family.
  • The only Egyptian prednisone tablet is 5 mg, so a 60 mg dose means twelve tablets - check the patient can actually take the course before prescribing it.
Egyptian brands
Egyptian brandManufacturerIndicative price
HOSTACORTIN 5MG 30 TAB.SANOFI AVENTIS > SANOFI12.00 EGP (0.40/unit)

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.