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25 Treatment of Cluster Headache and Other Trigeminal Autonomic Cephalalgias
Cluster headache is one of a group of primary headache disorders (trigeminal autonomic cephalalgias) of uncertain mechanism that are characterized by frequently recurring, short-lasting but extremely severe headache. Involvement of the suprachiasmatic nucleus of the hypothalamus, the biological clock, has been correlated to clinical features and abnormalities of circadian rhythm seen in cluster headaches. It probably affects about 1/1,000 adults with characteristically recognizable features at ratio of 5:1 in men to women.
Symptomatic acute treatments include triptans and inhalational oxygen. A wide range of preventative medication is considered depending on the length of cluster attacks, not by whether the patient has episodic or chronic form. Refractory drug-resistant chronic cluster headache is the unique form eligible for surgical choices.
The prevalence of cluster headache is