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Cluster headache (CH) is the most common of the trigeminal autonomic cephalalgias, which also includes paroxysmal hemicrania and short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT). All have cyclical episodes of severe head pain with cranial autonomic activation (conjunctival injection, lacrimation, nasal congestion, rhinorrhea, forehead and facial sweating, miosis, ptosis, or eyelid edema). An individual attack is called a CH or cluster attack. Attacks occur in series that last for weeks or months, called cluster periods, with the attack frequency ranging from one every other day to 8 a day. The cluster periods are separated by remissions that usually last months to years.1 About 10% of patients have chronic CH (CCH): attacks that occur for more than 1 year with no remission periods or with remissions lasting less than 1 month.2 CH attacks are shorter than migraine, lasting from 15 minutes to 3 hours. The pain is unilateral and very severe; it is usually located in or around the eye or in the temporal region. It is often described as boring, tearing, or burning, or as if “a hot poker is in the eye” or …
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