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Cluster headache: pathophysiology, diagnosis and treatment

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Abstract

Cluster headache (CH) is characterized by attacks of severe, strictly unilateral pain that is orbital, supraorbital, temporal, or any combination of these, lasts 15–180 min, and occurs from once every other day to eight times a day. The pain is associated with ipsilateral conjunctival injection, lacrimation, nasal congestion, rhinorrhea, forehead and facial sweating, miosis, ptosis and/or eyelid edema, and/or with restlessness or agitation. The understanding of the pathophysiological mechanisms behind CH is far from complete, but CH is considered to be a neurovascular and chronobiologic headache disorder, with a pivotal role played by the central brain mechanisms. The diagnosis of CH is based on a careful history that elicits the clinical features of attacks, ipsilateral autonomic phenomena, and the cyclical nature of the bouts in which the attacks occur. Additional diagnostic interventions are needed to rule out secondary causes of CH. The main focus of therapy is to abort attacks once they have begun and to prevent future attacks. Alternative interventions in patients with CH who have not experienced any meaningful benefit from preventive drugs are well defined. Although there have been advances in the diagnosis and therapy of CH, a significant number of CH patients experience misdiagnoses and diagnostic delay, which stalls the possibility of the timely application of adequate abortive and preventive therapy.

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Authors and Affiliations

  1. Faculty of Medicine, University of Nis, Blvd. Zorana Djindjica 81, 18 000, Nis, Serbia

    Srdjan Ljubisavljevic

  2. Clinic for Neurology, Clinical Center Nis, Nis, Serbia

    Srdjan Ljubisavljevic

  3. Faculty of Medicine, University of Belgrade, Belgrade, Serbia

    Jasna Zidverc Trajkovic

  4. Clinic for Neurology, Clinical Center Serbia, Belgrade, Serbia

    Jasna Zidverc Trajkovic

Authors
  1. Srdjan Ljubisavljevic
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  2. Jasna Zidverc Trajkovic
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Contributions

Conception and design: SL. Acquisition of data: SL. Analysis and Interpretation of data: SL, JZT. Drafting the manuscript: SL. Revising it for intellectual content: SL, JZT. Final approval of the completed manuscript: SL, JZT.

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Correspondence to Srdjan Ljubisavljevic.

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Ljubisavljevic, S., Zidverc Trajkovic, J. Cluster headache: pathophysiology, diagnosis and treatment. J Neurol 266, 1059–1066 (2019). https://doi.org/10.1007/s00415-018-9007-4

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  • DOI: https://doi.org/10.1007/s00415-018-9007-4

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