Treatment in New Zealand

Effective treatment exists. Here's how to access it in NZ.

Cluster headache is highly treatable once correctly diagnosed. Here's every treatment available in New Zealand, and how to access it.

Clinically reviewed · This page was clinically reviewed on 8 September 2026. It is based on ICHD-3 criteria and published clinical guidelines, and is not a substitute for medical advice. How we prepare clinical content
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The treatment pathway at a glance

Cluster headache is usually managed in four stages. Most people use treatments from more than one stage at the same time.

Stage 1

Abort attacks

Fast-acting acute treatment to stop an attack in progress: oxygen and sumatriptan.

Stage 2

Bridge

Short-term transitional therapy to settle attacks while prevention takes effect.

Stage 3

Prevent

Daily preventive medication to reduce frequency; verapamil is first-line.

Stage 4

Escalate

Specialist options for cases that don't respond to first-line treatment.

Guideline basis

This overview is aligned with the 2023 European Academy of Neurology (EAN) cluster headache treatment guideline. New Zealand oxygen-access wording also draws on the 2024 Thoracic Society of Australia and New Zealand (TSANZ) adult home oxygen guideline for supply, safety and equipment context. Funding and supplier processes change, so clinicians should confirm current requirements before prescribing: PHARMAC for medicines, and Health NZ's community oxygen service for oxygen. Health NZ confirmed in July 2026 that it funds high-flow oxygen for cluster headache and that PHARMAC does not.

Stage 1 · Acute (abortive) treatments

Acute treatments abort an attack in progress. Standard pain relief (paracetamol, ibuprofen, even codeine) does not work for cluster headache, since the attack peaks too fast. These are the evidence-based options that do.

First-line Health NZ funded · access varies EAN 2023

Oxygen therapy

High-flow oxygen (12–15 L/min via non-rebreather mask, 15–20 minutes) is a first-line acute treatment. Health NZ confirmed in July 2026 that it funds this for cluster headache. It is a medical gas needing the right mask, regulator and supplier account to access.

Access oxygen in NZ →
First-line PHARMAC funded

Sumatriptan (injectable)

A 6mg subcutaneous injection works within about 10–15 minutes for most patients and is PHARMAC-funded. The key is getting the injectable form prescribed, not tablets, which work too slowly for CH.

Learn about sumatriptan →

Stage 2 · Transitional (bridging) treatments

Short-term therapies used at the start of a cluster period or during severe escalation. They can reduce attacks quickly while a preventive such as verapamil is being started or increased.

Short-term bridge

Prednisone, prednisolone and nerve blocks

Oral corticosteroids and specialist-delivered greater occipital nerve blocks bridge the gap while longer-term prevention takes effect. They need medical supervision and are not long-term maintenance treatment.

Read about bridging therapy →

Stage 3 · Preventive treatments

Taken daily to dramatically reduce how often attacks occur and how severe they are. Most important for people with chronic cluster headache or frequent episodic periods.

First-line preventive PHARMAC funded

Verapamil

The most widely used preventive worldwide. Effective CH doses (up to 480–720 mg/day, occasionally higher under specialist supervision) are higher than cardiac doses and require ECG monitoring. Available and funded in New Zealand.

Learn about verapamil →
Second-line options

Other preventive options

Lithium, topiramate, melatonin, CGRP monoclonal antibodies and other options, including what is available in New Zealand and when each might be considered.

Explore preventives →

Stage 4 · Alternative and emerging treatments

Important note on this section

Some treatments here are currently illegal in New Zealand or not yet approved. This section presents the evidence as it exists, clearly states the legal position in New Zealand, and does not encourage illegal activity. It is being prepared for clinical review.

Emerging Read the legal status

Alternative and emerging treatments

Psilocybin, neuromodulation devices (gammaCore), ketogenic diet, ketamine and anti-CGRP therapies: what the research shows, what is legally accessible in New Zealand, and what patients are reporting.

Explore alternative treatments →