- Guideline for the Treatment of Cluster Headache: A Clinical Practice Guideline from the Korean Headache Society
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Byung-Su Kim, Pil-Wook Chung, Hong-Kyun Park, Mi Ji Lee, Jae Myun Chung, Kyung Min Kim, Jiyoung Kim, Heui-Soo Moon, Dae-Woong Bae, Jong-Hee Sohn, Tae-Jin Song, Wonwoo Lee, Soohyun Cho, Myoung-Jin Cha, Yun-Ju Choi, Miyoung Choi
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Received March 22, 2026 Accepted April 15, 2026 Published online May 19, 2026
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DOI: https://doi.org/10.62087/hpr.2026.0011
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 Abstract
- Purpose: This clinical practice guideline (CPG) was developed by the Korean Headache Society (KHS) to provide evidence-based recommendations for the acute and preventive treatment of cluster headache (CH).
Methods
The CPG Committee of the KHS identified key clinical questions regarding the acute and preventive treatment of CH through a systematic literature review. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess the quality of evidence and determine the strength of the evidence-based recommendations.
Results
For acute treatment, subcutaneous sumatriptan, intranasal zolmitriptan, intranasal sumatriptan, oral zolmitriptan, and oxygen are strongly recommended based on moderate-quality evidence. For preventive treatment, suboccipital steroid injection, oral corticosteroids, and galcanezumab (specifically for episodic CH) are strongly recommended based on moderate-quality evidence. Despite the low quality of evidence, verapamil is also strongly recommended, whereas lithium is recommended with a weaker strength of recommendation. Other oral triptans, NSAIDs, ergot derivatives, subcutaneous octreotide, intranasal lidocaine, and non-invasive vagus nerve stimulation (nVNS; specifically for episodic CH) are recommended for acute treatment based on expert consensus. For preventive treatment, topiramate, valproic acid, melatonin, and nVNS (as adjunctive therapy specifically for chronic CH) are recommended, whereas sphenopalatine ganglion stimulation, occipital nerve stimulation, and deep brain stimulation are recommended for patients with refractory chronic CH based on expert consensus.
Conclusion
This CPG provides evidence-based recommendations for the treatment of CH. In addition, the authors recommend the use of expert consensus-based treatments to bridge the gap between the available evidence and real-world clinical practice.
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KHS
