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Clinical description and treatment of cluster headache Volume 19, issue 6, Juin 2007

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Centre d’Urgence des Céphalées, Hôpital Lariboisière, 75475 Paris cedex 10

Cluster headaches are attacks of severe, strictly unilateral pain that is orbital or temporal, lasting 15 to 180 minutes and occurring from once every other day to eight times a day. The attacks are associated with at least one of the following : lacrimation, nasal congestion, rhinorrhea and most patients are restless or agitated during an attack. Attacks occur in series of weeks or months (cluster periods) separated by remission periods, usually lasting months or years. Cluster headache is most often episodic but about 10 to 15 % are chronic. Acute therapy for cluster headache includes oxygen inhalation and triptans (especially sumatriptan by subcutaneous injection). The aim of prevention is to stop all attacks if possible or at least to bring attacks under control and maintain relief with minimal side effects. Preventive drugs commonly advocated are verapamil, lithium and topiramate. Injection of local anesthetic plus corticosteroid around the greater occipital nerve ipsilateral to the pain has been widely used. Hypothalamic stimulation is reserved to intractable chronic cluster headache.