Give propranolol in divided doses. Give diltiazem in divided doses or daily in slow-release form. Slow-release form is available. Amitriptyline is good for patients with insomnia. Give cyproheptadine in divided doses.
Prednisone is indicated for cluster headaches.
Butalbital can be addictive. These agonists are contraindicated in cardiovascular, cerebrovascular or peripheral vascular disease. Avoid use within 24 hr of other 5-HT 1 or ergots. Avoid in patients with pregnancy, hypertension, coronary artery disease, and peripheral vascular disease. Avoid use within 24 hr of other ergots or 5-HT 1 agonists.