Cluster Headaches — The Good and the Bad
First the bad. High flow oxygen therapy has been recognized for decades to be safe and effective as an “abortive” treatment for cluster headaches. CMS, the agency that administers Medicare and Medicaid, has refused again to pay the $200–300 monthly cost, a pittance for CMS but a burden for many cluster patients. The agency acted despite three published, prospective, controlled and randomized trials. As private insurers often follow Medicare’s lead, the refusal will affect up to 1 million cluster sufferers in the US.
Now the good. Galcanezumab, of the three available CGRP monoclonal antibodies now widely used to prevent migraine, has received FDA approval to treat cluster as well. Current off-label preventatives are mainly high-dose verapamil, lithium and steroids. They each commonly have side effects and occasionally serious risks. The CGRP antibodies, on the other hand, have so far shown good safety, tolerability and efficacy.
See Neurology Today, September 5, 2019.