What is the first-line treatment for a cluster headache?

The first-line treatment for a cluster headache is 100% oxygen. Cluster headaches are characterized by excruciating pain typically located around one eye, and they can occur in cyclical patterns or clusters. Inhalation of pure oxygen can provide rapid relief by causing vasoconstriction of cerebral blood vessels, which counteracts the dilation that occurs during an attack.

This treatment is particularly effective because it addresses the headache's vascular component and can significantly reduce the severity and duration of the pain when administered at the onset of an attack. The recommendation is to use a non-rebreather mask at a flow rate of about 7-15 liters per minute for 15-20 minutes.

While triptans are commonly used in treating migraines and can also be effective for cluster headaches, they are not typically the first-line choice due to the need for fast-acting relief and the potential for side effects. NSAIDs may help in some cases, but they do not provide the prompt relief needed during cluster headache attacks. Beta-blockers are generally more useful in the preventive treatment of cluster headaches rather than during acute episodes. Therefore, 100% oxygen stands out as the immediate and preferred intervention for managing cluster headache attacks.