CLUSTER HEADACHE AND RELATED DISORDERS

Abstract

Cluster headache belongs to Trigeminal Autonomic Cephalalgias (TAC). They are a group of primary headache disorders that are characterized by recurrent attacks of unilateral trigeminal distribution pain accompanied by one or more ipsilateral cranial autonomic symptoms. Diagnosis is based on patient’s headache history in association with diagnostic criteria provided by International Headache Society. Cluster headache is often misdiagnosed and undertreated. It affects predominantly young males.Headache attacks are clustered in bouts and may occur at precise hours especially at nights. During the attacks, sufferers feel excruciatingly severe pain and report restlessness and aggressiveness.Up to now, curative treatment is not available. The management of this disorder consists of acute treatment to alleviate pain and prophylactic treatment to reduce the number of attacks during bouts. Acute therapy is based on subcutaneous sumatriptan, nasal spray zolmatriptan and high flow oxygen. Verapamil, lithium and corticosteroids remain the main prophylactic treatment. Newer therapeutic choices like deep brain stimulation and greater occipital nerve stimulation are promising especially in some refractory patients.