{ "schema_version": 1, "kind": "condition", "id": "cluster-headache", "name": "Cluster headache (acute attack & prophylaxis)", "category": "chronic", "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", "review_status": "reviewed", "verified_against": "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_date": "2026-08", "treatments": [ { "id": 441, "generic": "Sumatriptan", "line": 1, "is_adjunct": false, "form": "injection", "strength_mg": 6.0, "adult_dose": "6 mg subcutaneously at onset of attack; max 12 mg in 24 hours (minimum 1 hour between doses)", "adult_duration": "acute attack", "dose_source": "Sumatriptan 6 mg/0.5 mL solution for injection SmPC sections 4.2-4.3 (eMC product 607)", "rationale": "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." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not recommended in children under 18 years for cluster headache", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "SUMIGRAN 6MG/0.5 ML PREFILLED SYRINGE", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SIGMA TEC", "price_egp": 30.0, "pack_count": null, "unit_price": null, "strength_mg": 6.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SUMAGRAINE 6MG AMP.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "UP PHARMA", "price_egp": 40.0, "pack_count": null, "unit_price": null, "strength_mg": 6.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "cluster-headache" }, { "id": 442, "generic": "Oxygen", "line": 1, "is_adjunct": false, "form": "nasal", "strength_mg": null, "adult_dose": "100% Oxygen at 12-15 L/min via non-rebreather mask with reservoir bag for 15-20 minutes", "adult_duration": "acute attack", "dose_source": "NICE Guideline CG150", "rationale": "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." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Specialist pediatric neurology guidance required", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "cluster-headache" }, { "id": 443, "generic": "Verapamil", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 80.0, "adult_dose": "80 mg 3 times daily, titrate by 80 mg every 3-14 days up to 240-480 mg daily in divided doses", "adult_duration": "prophylaxis (during cluster bout)", "dose_source": "Egyptian National Drug Formulary - Cardiovascular 2024 (verapamil monograph)", "rationale": "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." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not indicated for cluster headache prophylaxis in children", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "VERPAMIL 80MG 20 F.C.TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NASR", "price_egp": 7.0, "pack_count": 20, "unit_price": 0.35, "strength_mg": 80.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "VERATENS 80MG 10 F.C. TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHAROPHARMA", "price_egp": 4.75, "pack_count": 10, "unit_price": 0.47, "strength_mg": 80.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "IZOPTOMIL 80 MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ARAB DRUG COMPANY (ADCO)", "price_egp": 10.0, "pack_count": 20, "unit_price": 0.5, "strength_mg": 80.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ISOPTIN 80 MG 30 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA > ABBOTT LABORATORIES", "price_egp": 50.0, "pack_count": 30, "unit_price": 1.67, "strength_mg": 80.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "cluster-headache" }, { "id": 444, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": null, "adult_duration": null, "dose_source": "Cluster Headache - disease-level clinical article (cluster-headache-full.txt)", "rationale": "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." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": null, "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "cluster-headache" }, { "id": 445, "generic": "Prednisone", "line": 1, "is_adjunct": true, "form": "oral.solid", "strength_mg": 5.0, "adult_dose": "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.", "adult_duration": "At least five days at the full dose, then a taper of 10 mg a day - a short course only", "dose_source": "Cluster Headache - StatPearls - NCBI Bookshelf (NBK544241) - the disease article carries both the indication and this dose", "rationale": "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." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "No paediatric dose in the sources opened - cluster headache in a child belongs with a neurologist.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "HOSTACORTIN 5MG 30 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANOFI AVENTIS > SANOFI", "price_egp": 12.0, "pack_count": 30, "unit_price": 0.4, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "cluster-headache" } ] }