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Original Article
- Guideline for the Treatment of Cluster Headache: A Clinical Practice Guideline from the Korean Headache Society
- 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
- Headache Pain Res. 2026;27(2):124-144. Published online June 30, 2026
- DOI: https://doi.org/10.62087/hpr.2026.0011
- 1,142 View
- 27 Download
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Abstract
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Supplementary Material - 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.
Review Articles
- Understanding the Connection between the Glymphatic System and Migraine: A Systematic Review
- Myoung-Jin Cha, Kyung Wook Kang, Jung-won Shin, Hosung Kim, Jiyoung Kim
- Headache Pain Res. 2024;25(2):86-95. Published online July 31, 2024
- DOI: https://doi.org/10.62087/hpr.2024.0014
- 11,199 View
- 176 Download
- 6 Citations
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Abstract
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- The glymphatic system is a brain-wide perivascular pathway that functions similarly to the lymphatic system in the periphery of the body, playing a crucial role in removing waste from the brain. Although impaired glymphatic function has a well-known relationship with neurodegenerative diseases through abnormal protein accumulation, it is also associated with migraine. While still in its nascent phase, research on the glymphatic system in migraine patients is gradually increasing. This systematic literature review focuses on studies investigating the glymphatic system in migraineurs. Furthermore, it examines the methods used to evaluate the glymphatic system in these studies and their main findings.
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Citations
Citations to this article as recorded by
- Chronic Migraine Is Associated With Region-Specific High-Grade Enlarged Perivascular Spaces: Retrospective Matched Case-Control Study
Jae Wook Cho, Gha-Hyun Lee, Jiyoung Kim
Journal of Clinical Neurology.2026; 22(1): 113. CrossRef - No Glymphatic Dysfunction in Trigeminal Neuralgia: A Preliminary Study
Barış Genç, Kerim Aslan
Brain and Behavior.2026;[Epub] CrossRef - Brain Glymphatic and Lymphatic Systems in Migraine: Mechanistic Insights and Neuromodulation Perspectives with an Emphasis on Ultrasound-Based Approaches
Jaeho Kim
Headache and Pain Research.2026; 27(1): 13. CrossRef - New Directions in Migraine Pathophysiology: The Glymphatic System and PACAP
Dan Iulian Cuciureanu, Cătălina Elena Bistriceanu, Georgiana-Anca Vulpoi, Victor Constantinescu, Diana Laura Blajuta, Ana-Maria Nădejde, Florina Antochi, Adina-Maria Roceanu
Life.2026; 16(5): 767. CrossRef - Comments on “Brain Glymphatic and Lymphatic Systems in Migraine: Mechanistic Insights and Neuromodulation Perspectives with an Emphasis on Ultrasound-Based Approaches”
Soo-Jin Cho
Headache and Pain Research.2026; 27(2): 169. CrossRef - Diffusion Tensor Imaging-Based Glymphatic Dysfunction Assessments in Migraine Syndromes: Mechanisms and Diagnostic Implications
Emily Lai, Joshua Estin, Jiahao Zhou, Roger Sheffmaker, Manisha Koneru
Biomedicines.2025; 13(12): 2981. CrossRef
- Chronic Migraine Is Associated With Region-Specific High-Grade Enlarged Perivascular Spaces: Retrospective Matched Case-Control Study
- Migraine and Stroke
- Myoung-Jin Cha, Ha Yeun Oh, Jiyoung Kim
- Korean J Headache. 2023;24(2):50-55. Published online December 31, 2023
- 1,197 View
- 24 Download
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Abstract
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- The relationship between migraine and stroke is intricate and bidirectional. Migraine, a neurological disorder characterized by severe headaches and associated symptoms, exhibits some similarities in presentation with stroke. Conversely, stroke can at times mimic migraine symptoms. Migrainous infarction is directly associated with stroke. Specifically, migraine with aura has been linked to an increased risk of ischemic stroke. Migraine with aura and the frequency of headaches are considered risk factors for stroke. Moreover, migraine is associated with subclinical infarct-like brain lesions and white matter changes. Additionally, some genetic disorders predispose individuals to develop both migraine and stroke. In this review, we aim to investigate the relationship between migraine and stroke.
- Diagnosis and Exclusion of Dangerous Headache in Headache Clinic Patients
- Jiyoung Kim, Kyoung Jin Hwang
- Korean J Headache. 2023;24(1):11-16. Published online June 30, 2023
- 976 View
- 21 Download
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Abstract
PDF
- There are many different types of headaches, but they can be broadly classified as primary and secondary headaches. The Diagnosis of Headaches involves understanding the epidemiology of headaches, identifying the signs of secondary headaches, and applying the diagnostic criteria outlined in the International Classification of Headache Disorders. Clinicians should have a clear understanding of SNNOOP10 to indicate secondary headache. Furthermore, the evaluation of patients who present with a thunderclap headache should be conducted with great care and detail.
- Update on Treatment of Giant Cell Arteritis
- Mi-Kyoung Kang, Yoo Hwan Kim, Kyeong Min Son, Soo-Jin Cho, Jiyoung Kim, Jong-Hee Sohn, On behalf of the Hallym Headache Research Society
- Published online December 31, 2022
- 848 View
- 73 Download
- Diagnostic Delay in Spontaneous Intracranial Hypotension
- Jiyoung Kim, Younjin Park, Jong-Hee Sohn, Sang-Hwa Lee, Eun Kyung Khil, Hee Jin Im, Min Jun Song, Myoung-Jin Cha, Soo-Jin Cho
- Published online June 30, 2022
- 1,043 View
- 126 Download
- Status of Chronic Migraine Prophylactic Treatment in Clinical Practice
- Jae Seob Yoon, Jiyoung Kim
- Published online June 30, 2021
- 884 View
- 111 Download
- Thunderclap Headache Attributed to Spinal Subarachnoid Hemorrhage
- Nae Ri Kim, Jiyoung Kim
- Published online June 30, 2021
- 815 View
- 66 Download
- Diagnosis and Treatment of Tension-type Headache
- Myoung-Jin Cha, Jiyoung Kim, Ph.D.
- Published online June 30, 2020
- 1,194 View
- 199 Download
- Does Insomnia Cause Migraines or Is It an Issue of Comorbidity?
- Jiyoung Kim
- Published online December 31, 2015
- 1,153 View
- 124 Download
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