19th June 2023

Management

• Subcutaneous or nasal triptan
• Zolmitriptan nasal spray (unlicensed)
• Offer short burst oxygen therapy – 100% oxygen at 12-15 litres/min via a non-rebreather face mask for 15-20 mins. Provision of home oxygen.

NICE does not recommend offering paracetamol, NSAIDs, opioids, ergots or oral triptans for acute treatment.

Pharmacological Prevention

• Verapamil
• Lithium (unlicensed)

Paroxysmal hemicrania

Paroxysmal hemicrania, like cluster headache, is a trigeminal autonomic cephalgia. The presentation is similar and can include headache and autonomic symptoms like those of cluster headaches. However, chronic paroxysmal hemicrania have an increased frequency of attacks (up to 15 in 24 hrs) and tend to have a shorter duration of attacks (5-30 mins) compared to cluster headaches. Paroxysmal hemicrania often responds well to indomethacin therapy.