Condition

Cluster Headache

Severe headaches occurring in cyclical patterns

4.2M
People Affected
15
Active Trials
800K
New Cases/Year

Treatment Rankings

Ranked by evidence volume first. Medicine has spent centuries ranking things by vibes. This is an improvement.

1
Sumatriptan (subcutaneous)
90% Effectiveness• 90% Confidence• 68% Safety• 55 trials• 5.5K participants
HIGH EvidenceGood ValueDose: 6 mg subcutaneous
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
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Chemo☢️
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Morphine💊
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68
DangerousModerateSafe

Time to Effect

5-10 minutes

Duration

As needed (acute)

Response Rate

75%

Remission Rate

%

Number Needed to Treat (NNT)

2.5

Common Side Effects:

Injection site reaction: 15%
Chest discomfort: 4%
Dizziness: 3%
Nausea: 3%

Annual Cost of Care

Drug Cost

$2,700

Monitoring

$1,000

Side Effects

$50

Total Annual

$3,750

Cost-Effectiveness

GOOD

QALYs Gained

0.15

Cost per Responder

$3,667

Treatment Outcomes
Efficacy Outcomes
Overall Effectiveness
+90%
Response Rate
+75%
Common Side Effects
Injection site reaction
+15%
Chest discomfort
+4%
Dizziness
+3%

Clinical Trial Phases:

Phase 4
2
High-flow Oxygen
88% Effectiveness• 85% Confidence• 95% Safety• 1 trials• 800 participants
HIGH EvidenceExcellent ValueDose: 12-15 L/min via non-rebreather mask
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
95
DangerousModerateSafe

Time to Effect

10-15 minutes

Duration

15-20 minutes per attack

Response Rate

75%

Remission Rate

%

Number Needed to Treat (NNT)

2.5

Common Side Effects:

Dry nasal passages: 8%
Nasal irritation: 3%

Annual Cost of Care

Drug Cost

$750

Monitoring

$1,000

Side Effects

$20

Total Annual

$1,770

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.15

Cost per Responder

$1,027

Treatment Outcomes
Primary Outcomes
Headache Pain Intensity (NRS)8/10
-75% (-6 points)
Proportion of Attacks Aborted (Pain-free at 15 minutes)10%
+600% (+60 percentage points)
Relief of Associated Autonomic Symptoms (Ptosis Severity Score 0-3)2/3
-50% (-1 point)
Secondary Benefits
Time to Significant Pain Relief (">=\" 50% reduction)45 minutes
-77.8% (-35 minutes)
Recurrence Rate within 24 hours50%
-20% (-10 percentage points)
Use of Rescue Medication80% of attacks
-75% (-60 percentage points)
Common Side Effects
Dry nasal passages
+8%
Nasal irritation
+3%

Clinical Trial Phases:

Phase 4
3
Galcanezumab
85% Effectiveness• 85% Confidence• 85% Safety• 3 trials• 1.2K participants
HIGH EvidencePoor ValueDose: 300 mg subcutaneous monthly
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
85
DangerousModerateSafe

Time to Effect

1 week

Duration

3-6 months per cluster period

Response Rate

65%

Remission Rate

%

Number Needed to Treat (NNT)

4

Common Side Effects:

Injection site reaction: 15%
Constipation: 3%

Annual Cost of Care

Drug Cost

$34,500

Monitoring

$300

Side Effects

$50

Total Annual

$34,850

Cost-Effectiveness

POOR

QALYs Gained

0.4

ICER

$200,000/QALY

Cost per Responder

$53,615

Treatment Outcomes
Primary Outcomes
Weekly Cluster Headache Attack Frequency17.8 attacks/week
-23% (-4.1 attacks/week)
Patients achieving >=50% reduction in weekly attack frequencyPlacebo: 8% of patients
+787.5% (+63 percentage points)
Severity of Cluster Headache Attacks (NRS)NRS pain score: 8/10
-22.5% (-1.8 points)
Secondary Benefits
Weekly Use of Acute Abortive Medication13.5 doses/week
-37% (-5.0 doses/week)
Headache Impact Test (HIT-6) ScoreHIT-6 score: 62
-11.3% (-7 points)
Patients reporting 'much improved' or 'very much improved' on PGI-IPlacebo: 15% of patients
+366.7% (+40 percentage points)
Common Side Effects
Injection site reaction
+15%
Constipation
+3%

Clinical Trial Phases:

Phase 3Phase 4
4
Verapamil
80% Effectiveness• 80% Confidence• 70% Safety• 3 trials• 2.5K participants
HIGH EvidenceGood ValueDose: 240-720 mg/day (extended-release)
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
70
DangerousModerateSafe

Time to Effect

1-2 weeks

Duration

Months to years

Response Rate

65%

Remission Rate

%

Number Needed to Treat (NNT)

5

Number Needed to Harm (NNH)

10

Common Side Effects:

Constipation: 35%
Bradycardia: 15%
Hypotension: 8%
Fatigue: 7%
Dizziness: 7%

Annual Cost of Care

Drug Cost

$360

Monitoring

$500

Side Effects

$100

Total Annual

$960

Cost-Effectiveness

GOOD

QALYs Gained

0.3

Cost per Responder

$1,477

Treatment Outcomes
Primary Outcomes
Weekly Cluster Headache Attack Frequency12 attacks/week
-60% (-7.2 attacks/week)
Cluster Headache Attack Severity (NRS)NRS score: 9/10 (severe pain)
-30% (-2.7 points on NRS)
Average Cluster Headache Attack Duration60 minutes
-35% (-21 minutes)
Weekly Acute Abortive Medication Use10 doses/week
-55% (-5.5 doses/week)
Secondary Benefits
Headache Impact Test-6 (HIT-6) ScoreHIT-6 score: 65/78 (very severe impact)
-20% (-13 points on HIT-6 scale)
Pittsburgh Sleep Quality Index (PSQI) ScorePSQI score: 12/21 (poor sleep quality)
-25% (-3 points on PSQI)
Migraine Disability Assessment (MIDAS) ScoreMIDAS score: 20 (severe disability)
-40% (-8 points on MIDAS)
Common Side Effects
Constipation
+35%
Bradycardia
+15%
Hypotension
+8%

Clinical Trial Phases:

Phase 4
5
Zolmitriptan (nasal spray)
80% Effectiveness• 80% Confidence• 68% Safety• 12 trials• 600 participants
HIGH EvidenceGood ValueDose: 5 mg or 10 mg nasal spray
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
68
DangerousModerateSafe

Time to Effect

15-30 minutes

Duration

As needed (acute)

Response Rate

65%

Remission Rate

%

Number Needed to Treat (NNT)

3.5

Common Side Effects:

Taste disturbance: 15%
Nausea: 7%
Dizziness: 7%
Somnolence: 7%

Annual Cost of Care

Drug Cost

$3,600

Monitoring

$1,000

Side Effects

$50

Total Annual

$4,650

Cost-Effectiveness

GOOD

QALYs Gained

0.15

Cost per Responder

$5,615

Treatment Outcomes
Efficacy Outcomes
Overall Effectiveness
+80%
Response Rate
+65%
Common Side Effects
Taste disturbance
+15%
Nausea
+7%
Dizziness
+7%

Clinical Trial Phases:

Phase 4
6
Lithium
75% Effectiveness• 75% Confidence• 30% Safety• 18 trials• 1.1K participants
MODERATE EvidenceGood ValueDose: 600-1200 mg/day (titrated to serum levels)
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
30
DangerousModerateSafe

Time to Effect

1-2 weeks

Duration

Months to years

Response Rate

55%

Remission Rate

%

Number Needed to Treat (NNT)

6

Number Needed to Harm (NNH)

7

Common Side Effects:

Tremor: 25%
Polyuria/Polydipsia: 25%
Nausea: 15%
Weight gain: 15%
Hypothyroidism: 8%

Annual Cost of Care

Drug Cost

$240

Monitoring

$900

Side Effects

$200

Total Annual

$1,340

Cost-Effectiveness

GOOD

QALYs Gained

0.2

Cost per Responder

$2,436

Treatment Outcomes
Efficacy Outcomes
Overall Effectiveness
+75%
Response Rate
+55%
Common Side Effects
Tremor
+25%
Polyuria/Polydipsia
+25%
Nausea
+15%

Clinical Trial Phases:

Phase 4
7
Topiramate
70% Effectiveness• 70% Confidence• 60% Safety• 1 trials• 550 participants
MODERATE EvidenceGood ValueDose: 100-400 mg/day
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
60
DangerousModerateSafe

Time to Effect

2-4 weeks

Duration

Months to years

Response Rate

45%

Remission Rate

%

Number Needed to Treat (NNT)

7

Number Needed to Harm (NNH)

12

Common Side Effects:

Paresthesia: 50%
Cognitive slowing: 25%
Fatigue: 15%
Appetite suppression: 15%
Kidney stones: 1.5%

Annual Cost of Care

Drug Cost

$300

Monitoring

$400

Side Effects

$100

Total Annual

$800

Cost-Effectiveness

GOOD

QALYs Gained

0.15

Cost per Responder

$1,778

Treatment Outcomes
Primary Outcomes
Cluster Headache Attack Frequency18 attacks/week
-35% (-6.3 attacks/week)
Cluster Headache Attack Severity (NRS)8.5/10 points
-17.6% (-1.5 points)
Acute Abortive Medication Uses15 uses/week
-40% (-6 uses/week)
Secondary Benefits
Headache Impact Test (HIT-6) Score63/78 points
-11.1% (-7 points)
Pittsburgh Sleep Quality Index (PSQI) Score12/21 points
-16.7% (-2 points)
Functional Impairment Score (0-30 scale)20/30 points
-25% (-5 points)
Common Side Effects
Paresthesia
+50%
Cognitive slowing
+25%
Fatigue
+15%

Clinical Trial Phases:

Phase 4