Cluster headache

Patients who smoke tobacco should be advised to stop. Patients should also be advised to avoid exposure to second-hand smoke.

Patients should be advised to follow their clinician’s recommendations on how to gradually increase the dose of their preventive drugs to their maximum. They must also be made aware that it can take several weeks to see the full effect of a drug. Patients are directed to taper slowly off preventive medications once they are completely headache-free for 2 weeks and/or once they have moved beyond their usual cluster period duration. In chronic disease, patients are advised to continue preventive medications for 6 months to 12 months before considering taper. Thereafter, the patient can periodically attempt to reduce or eliminate medication as long as headaches do not recur.

Patients who develop chest pain on triptans must inform the prescribing doctor as soon as possible and not re-use the triptans until reviewed.

Patients should be advised to avoid alcohol and other triggers where appropriate.

Patients should be asked about suicidal ideation at regular follow-up visits.

Pregnancy prevention program

Inform women of childbearing potential that they must follow a pregnancy prevention program while on treatment with valproic acid and its derivatives. Some countries may also require that a pregnancy prevention program is in place for other anticonvulsants (e.g., topiramate).