, Volume 28, Issue 11, pp 10-13
Date: 18 Dec 2012

Once correctly diagnosed, cluster headache can usually be adequately managed with pharmacological options

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The biggest obstacles in the management of cluster headache are under- and misdiagnosis. Once these have been overcome, the vast majority of patients achieve symptomatic relief of acute attacks with the use of oxygen inhalation and sumatriptan, and prevention of attacks with long-term maintenance prophylaxis with verapamil, lithium and/or other agents.

Terrible, characteristic pain

Of all of the primary headache syndromes, the pain from cluster headache is considered the most severe.[1,2] Indeed, it is arguably one of the most intense of all pain conditions.

Cluster headache is diagnosed exclusively by clinical presentation. The most important features are:[1,3]

  • the severity and location of the pain (severe or excruciating strictly unilateral pain in the retro-orbital area);

  • the duration of the attacks (15 minutes to 3 hours);

  • the frequency of attacks (from one attack every other day to eight attacks per day);

  • the presence of ipsilateral symptoms that accompany the headache (at least one of