neurologic disorders
Cluster Headache
Introduction
Cluster headaches cause excruciating, unilateral periorbital or temporal pain, with ipsilateral autonomic symptoms (ptosis, lacrimation, rhinorrhea, nasal congestion). Diagnosis is clinical. Acute treatment is with parenteral triptans,dihydroergotamine, or oxygen. Prevention is withverapamil,lithium,topiramate, divalproex,galcanezumab(a monoclonal antibody), or a combination. (See also Approach to the Patient With Headache .) Cluster headache affects primarily men, typically beginning at age 20 to 40; prevalence in the US is 0.4%. Usually, cluster headache is episodic; for 1 to 3 months, patients experience≥1 attack/day, followed by remission for months to years. Some patients have cluster headaches without remission. Pathophysiology is unknown, but the periodicity suggests hypothalamic dysfunction. Alcohol intake triggers cluster headache during the attack period but not during remission. 