Advances in cluster headache

The physician may have to combine the art and science of medicine in the management of this most fascinating of human ailments. The choice of drugs and the length of treatment prescribed are greatly influenced by the individual physician's experience, convictions, and reasoning. Needless to say, chronic use of narcotics should be avoided. The author's own regimen is to use combinations of ergotamine prophylaxis with either verapamil or prednisone in episodic cluster headache and with lithium for chronic cluster headache. Management of the treatment-resistant patient remains problematic, but a carefully performed trigeminal radiofrequency thermocoagulation procedure may be worthwhile.