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In this article we describe the clinical features,natural history,and clinical variants of cluster headaches,following the modern International Headache Society classification of cluster headaches in its two types; episodic and chronic.The basic pathophysiology is considered to be the trigeminal vascular system,the common final pain pathway,with pain initiated in a cyclical fashion by disordered central hypothalamic pacemaker.Oxygen,rapidly acting ergotamine,or dihydroergotamine preparations serve as abortive treatment of acute attacks;various pharmacotherapeutic options and combination therapies aid in the prophylaxis of cluster headache;and trigeminal radio frequency gangliorhizolysis is a very useful surgical approach in patients with chronic cluster headache who are resistant to medical treatment. |
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