Use transitional therapy to suppress attacks while preventive treatment is titrated, and monitor verapamil or neuromodulation choices with the same rigor applied to any high-risk long-term regimen.

Verapamil remains the main preventive therapy for cluster headache; Lithium and topiramate are reasonable alternatives when verapamil is limited; Prednisone taper and occipital nerve block can suppress attacks during titration; Neuromodulation is mainly reserved for refractory cluster headache; Cardiac monitoring is mandatory when escalating verapamil dose