PubMed · 10555664
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J E Mendizabal. 1999. Cluster headache.. https://doi.org/10.1001/archneur.56.11.1413
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EPIDEMIOLOGY: Cluster headache afflicts somewhat less than one in thousand in the general population. The majority of sufferers are men. CLINICAL FEATURES: The syndrome is characterized by frequent attacks of intense pain localized in and around the eye on one side, characteristically accompanied by conjunctival injection and lacrimation in this eye, along with nasal stuffiness on the same side and sometimes a Horner's syndrome. All symptoms and signs are strictly unilateral and occur during attacks lasting between 15 minutes and three hours. The attacks occur from once to eight times daily during a period lasting from some weeks to months. After a remission of varying duration, the same pattern recurs. PATHOPHYSIOLOGY: Recent findings suggest a pivotal role of the hypothalamus in relation to the pathophysiology. TREATMENT: Sumatriptan injection or oxygen inhalation aborts pain attacks in most patients. The most frequently used prophylactic agents are verapamil, lithium and steroids.
Cluster headache is an uncommon yet well-defined neurovascular syndrome occurring in both episodic and chronic varieties. The most striking feature of cluster headache is the unmistakable circadian and circannual periodicity. Inheritance may play a role in some families. The attacks are of extreme intensity, of short duration, occur unilaterally, and are accompanied by signs and symptoms of autonomic dysfunction. In contrast to migraine, during an attack the cluster patient prefers to pace about. Attacks frequently occur at night. Although the pathophysiology of cluster headache remains to be fully elucidated, several seminal observations have recently been made. The medical treatment of cluster headache includes both acute therapy aimed at aborting individual attacks and prophylactic therapy aimed at preventing recurrent attacks during the cluster period. Agents used for acute therapy include inhalation of oxygen, sumatriptan, and dihydroergotamine. Transitional prophylaxis involves the short-term use of either corticosteroids or ergotamine derivatives. The cornerstone of maintenance prophylaxis is verapamil, yet methysergide, lithium, and divalproex sodium may also be employed. In some patients, melatonin or topiramate may be useful adjunctive therapies.