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Cluster headache: Horton's cephalalgia revisited
J E Mendizabal1, E Umaña, R M Zweifler
1University of South Alabama Headache Center and the Department of Neurology, University of South Alabama College of Medicine, Mobile 36617, USA.
Insights
Cluster headache (CH) is a common primary headache disorder affecting middle-aged men, characterized by severe facial pain and autonomic symptoms. Current research explores its complex pathophysiology and modern treatment strategies.
Area of Science:
- Neurology
- Headache Medicine
Background:
- Cluster headache (CH) is a prevalent primary headache disorder.
- CH was not fully characterized until the 21st century.
Purpose of the Study:
- To review current literature on cluster headache (CH) and related cephalalgias.
- To present the latest evidence on CH pathophysiology and management.
Main Methods:
- Literature review of pertinent studies on CH and related cephalalgias.
Main Results:
- CH typically affects middle-aged men with cyclic patterns.
- Paroxysms involve excruciating facial pain (15-180 minutes) with autonomic symptoms (e.g., lacrimation, rhinorrhea, Horner's syndrome).
- Pathophysiology may involve autonomic, immunologic, and vascular factors.
Conclusions:
- Despite incomplete understanding of pathophysiology, recent evidence on anatomic and biochemical basis is presented.
- An update on modern CH management, including abortive, prophylactic, and invasive treatments, is provided.
Background:
Cluster headache (CH), though not fully characterized until this century, is a relatively common primary headache disorder.
Methods:
We reviewed pertinent literature on CH and related cephalalgias.
Results:
We found that CH typically occurs in middle-aged men and has a characteristic cyclic temporal pattern. During the cluster cycle, CH paroxysms last from 15 to 180 minutes and are manifested by excruciating periorbital or upper facial pain. Associated autonomic symptoms such as lacrimation, rhinorrhea, conjunctival injection, and Horner's syndrome are common in CH. Its pathophysiology is not entirely understood, though it may include a complex cascade of autonomic, immunologic, and vascular phenomena.
Conclusions:
Although its pathophysiology is still not completely understood, we present the most recent evidence regarding the underlying anatomic and biochemical basis for CH. We also present an update on the modern management of CH, including the appropriate use of standard and novel abortive and prophylactic agents, as well as more invasive treatment.