• Cluster headaches are a primary type of headache, distinguished by intensely painful attacks.

• Lifetime prevalence is approximately 0.12%, with a 1-year prevalence of 53 per 100,000 persons. The male-to-female ratio is about 4.3:1. In a Swedish cohort, the 1-year prevalence among the working-aged population was reported as 0.054%.

• Diagnostic Criteria (ICHD-III):
  • A. Must have at least five attacks that fulfill criteria B-D.
  • B. Severe or very severe unilateral orbital, supraorbital, and/or temporal pain lasting 15-180 minutes if untreated.
  • C. Accompanied by at least one of the following symptoms ipsilateral to the headache: conjunctival injection/lacrimation, nasal congestion/rhinorrhea, eyelid edema, forehead/facial sweating, miosis/ptosis, or a sense of restlessness/agitation.
  • D. Frequency of attacks ranges from once every other day to 8 per day.

• Acute Attack Management:
  • 100% Oxygen Therapy: A level A recommendation for cluster headaches, effective in about 66% of patients, taking effect in less than ten minutes.
  • Triptans: Subcutaneous sumatriptan or nasal spray zolmitriptan are level A-indicated therapies.
  • Alternatives: Octreotide, ergotamine, and intranasal lidocaine, although medication resistance occurs in 10-20% of severe cases.
• Preventive Treatment:
  • Suboccipital Blockade: The only level A recommended preventive method, with minimal side effects.
  • Verapamil: The most commonly prescribed prophylactic medication, starting at 240 mg once daily. Regular ECGs are recommended due to cardiac side effects.
  • Glucocorticoids: For short-term use in episodic cluster headaches, with a high response rate but significant long-term side effects.
  • Other Medications: Lithium, valproic acid, melatonin, and intranasal capsaicin have been used for prevention.
• Surgical and Neuromodulation Therapies:
  • Electrical Stimulation: Of the sphenopalatine ganglion, occipital, and vagus nerve. Deep brain stimulation of the hypothalamus has shown effectiveness in drug-resistant cases.
  • Vagus Nerve Stimulation: A non-implanted device option for patients.
• Physiotherapy: Currently, there are no established physiotherapy interventions for cluster headache patients, with only case studies exploring the combination of endogenous neurostimulation and physiotherapy.

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