Cluster headache

Cluster headache is a neurological disorder characterized by recurrent severe headaches on one side of the head, typically around the eye(s).^[1] There is often accompanying eye watering, nasal congestion, or swelling around the eye on the affected side.^[1] These symptoms typically last 15 minutes to 3 hours.^[2] Attacks often occur in clusters which typically last for weeks or months and occasionally more than a year.^[2] The disease is considered among the most painful conditions known to medical science.^[6][7]

The cause is unknown,^[2] but is most likely related to dysfunction of the posterior hypothalamus.^[8] Risk factors include a history of exposure to tobacco smoke and a family history of the condition.^[2] Exposures which may trigger attacks include alcohol, nitroglycerin, and histamine.^[2] They are a primary headache disorder of the trigeminal autonomic cephalalgias (TAC) type.^[2] Diagnosis is based on symptoms.^[2]

Recommended management includes lifestyle adaptations such as avoiding potential triggers.^[2] Treatments for acute attacks include oxygen or a fast-acting triptan.^[2][4] Measures recommended to decrease the frequency of attacks include steroid injections, galcanezumab, civamide, verapamil, or oral glucocorticoids such as prednisone.^[8][4][9] Nerve stimulation or surgery may occasionally be used if other measures are not effective.^[2][8]

The condition affects about 0.1% of the general population at some point in their life and 0.05% in any given year.^[5] The condition usually first occurs between 20 and 40 years of age.^[2] Men are affected about four times more often than women.^[5] Cluster headaches are named for the occurrence of groups of headache attacks (clusters).^[1] They have also been referred to as "suicide headaches".^[2]