What preventive treatments are available for patients with frequent cluster headache episodes, and how should they be monitored?

Preventive treatments for patients experiencing frequent cluster headache episodes include:

• Offer prophylactic treatment such as verapamil during a bout of cluster headache, with specialist advice before starting, including ECG monitoring for cardiac adverse effects ¹.
• Consider other prophylactic options like topiramate or propranolol after a full discussion of benefits and risks, especially if verapamil is unsuitable or ineffective ².
• In cases where first-line prophylaxis is ineffective or contraindicated, consider a course of up to 10 sessions of acupuncture according to patient preference and risk profile ².

Methods for monitoring preventative treatment include:

• Regular review to assess symptom response to treatment and monitor for adverse effects ¹.
• Seek specialist advice or referral if symptoms persist despite optimal management, or if there are atypical or refractory symptoms ¹.
• For verapamil, ECG monitoring is recommended before and during treatment to check for cardiac adverse effects ¹.