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Hallmarks of primary headache: part 3 - cluster headache
Gianluca Coppola1, Marco Antônio Arruda2, Messoud Ashina3,4
1Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino ICOT, Via Franco Faggiana, Latina, 1668 - 04100, Italy. gianluca.coppola@uniroma1.it.
The Journal of Headache and Pain
|October 2, 2025
Summary
Cluster headache (CH) is a severe neurological disorder causing excruciating pain and impacting quality of life. Understanding its complex pathophysiology and advocating for better support are crucial for affected individuals.
Area of Science:
- Neurology
- Headache Medicine
- Clinical Neuroscience
Background:
- Cluster headache (CH) is a rare, debilitating primary headache disorder.
- Characterized by severe unilateral pain and autonomic symptoms, CH significantly impairs daily functioning and quality of life.
- This review comprehensively examines CH, covering clinical presentation, diagnosis, pathophysiology, and therapeutic strategies.
Purpose of the Study:
- To provide a thorough understanding of cluster headache (CH).
- To explore current and novel therapeutic targets for CH management.
- To advocate for improved healthcare systems, health equity, and reduced stigma for CH patients.
Main Methods:
- Review of existing literature on cluster headache (CH).
- Analysis of clinical presentation, diagnostic challenges, and pathophysiology.
- Evaluation of current and emerging therapeutic interventions, including neuromodulation and complementary approaches.
Main Results:
- CH is often misdiagnosed, highlighting diagnostic challenges.
- Key pathophysiological factors include trigeminal-autonomic system activation, hypothalamic involvement, genetic factors, and the mesolimbic system.
- Neuromodulation and complementary therapies show potential, particularly for treatment-resistant cases.
Conclusions:
- CH pathophysiology is complex and multifactorial, requiring further research.
- Accurate diagnosis, advanced research, and strong psychosocial support are vital for improving patient outcomes.
- Advocacy for early diagnosis, reduced stigma, and enhanced patient support is essential.
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