title: Cluster headache: clinical features and therapeutic options.
abstract: BACKGROUND
  Cluster headache is the most common type of trigemino-autonomic headache, affecting ca. 120 000 persons in Germany alone. The attacks of pain are in the periorbital area on one side, last 90 minutes on average, and are accompanied by trigemino-autonomic manifestations and restlessness. Most patients have episodic cluster headache; about 15% have chronic cluster headache, with greater impairment of their quality of life. The attacks often possess a circadian and seasonal rhythm.
  
  
  METHODS
  Selective literature review
  
  
  RESULTS
  Oxygen inhalation and triptans are effective acute treatment for cluster attacks. First-line drugs for attack prophylaxis include verapamil and cortisone; alternatively, lithium and topiramate can be given. Short-term relief can be obtained by the subcutaneous infiltration of local anesthetics and steroids along the course of the greater occipital nerve, although most of the evidence in favor of this is not derived from randomized clinical trials. Patients whose pain is inadequately relieved by drug treatment can be offered newer, invasive treatments, such as deep brain stimulation in the hypothalamus (DBS) and bilateral occipital nerve stimulation (ONS).
  
  
  CONCLUSIONS
  Pharmacotherapy for the treatment of acute attacks and for attack prophylaxis is effective in most patients. For the minority who do not gain adequate relief, newer invasive techniques are available in some referral centers. Definitive conclusions as to their value cannot yet be drawn from the available data.
authors.affiliation: Klinik und Poliklinik für Neurologie, Westdeutsches Kopfschmerzzentrum,Universitätsklinikum Essen. Charly.Gaul@gmx.de
authors.forename: Charly
authors.initials: C
authors.lastname: Gaul
authors.forename: Hans-Christoph
authors.initials: HC
authors.lastname: Diener
authors.forename: Oliver M
authors.initials: OM
authors.lastname: Müller
mesh_terms: D000779:Anesthetics, Local / Q000008:administration & dosage; D002940:Circadian Rhythm; D003027:Cluster Headache / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D003430:Cross-Sectional Studies; D046690:Deep Brain Stimulation; D006801:Humans; D010102:Oxygen Inhalation Therapy; D011788:Quality of Life; D012621:Seasons; D014363:Tryptamines / Q000627:therapeutic use
chemical_list: D000779:Anesthetics, Local; D014363:Tryptamines