cluster headache – acute and prophylactic therapy

Avi Ashkenazi, MD; Todd Schwedt, MD


Cluster headache (CH) pain is considered the most severe of the primary headache syndromes and is arguably one of the most severe pain syndromes that afflict humans.[1] The disorder is characterized by attacks of severe, strictly unilateral pain, typically in the retro-orbital and fronto-temporal areas, associated with symptoms and signs of cranial autonomic dysfunction (tearing, conjunctival injection, rhinorrhea/nasal congestion, and Horner’s syndrome) ipsilateral to the pain. Patients typically pace restlessly during an acute attack. The hallmark of CH is the circadian periodicity of the attacks. Also, in episodic CH (ECH), the cluster periods often occur at predictable times of the year (circannual periodicity). Recent imaging studies confirm activation of the hypothalamus during CH attacks.[2] These findings may explain the characteristic periodicity of CH. Activation of the trigeminovascular system has also been shown during acute attacks.”


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