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Stomatologia 2004, 61(1):23-37
Review
CLUSTER HEADACHE. RECENT REVIEW OF THE LITERATURE
K. TRIANTAFILLIDOU-BIKA
SUMMARY Cluster headache (CH) is an extremely rare type of headache, characterized by recurrent, unilateral attacks of severe headache. The attacks appear in clusters, the so called "cluster periods". In general, the attacks are accompanied by autonomic symptoms, i.e. ipsilateral myosis, lacrimation, conjunctival infection, nasal congestion and rhinorrhea. Men are more often affected than women and the mean age at onset is generally between 20 and 40 years. Many theories have been developed to explain the pain, the vasodilatation, the autonomic features and the periodicity of the attacks. The genetic background of cluster headache and other headaches has attracted an increased interest in recent years. Other authors refer to the development of ipsilateral CH after the extraction of molar teeth. There is some evidence that CH is associated with head trauma or structural brain lesion. There are two clinical types of CH, the episodic CH and the chronic CH. Patients with episodic features may develop the chronic type, but, equally, some chronic forms may become episodic. The pharmacological management of CH can be divided into two phases: medications used for the acute episodes and those used to prevent future attacks for patients with chronic CH. Ergotamine was the best treatment for more than 60 years for episodic CH. Dihydroergotamine is also effective and may cause less arterial constriction than ergotamine. Sumatriptane is used, in the recent years, for the acute episodes of CH. New effective substances are vasodilator and antiepileptic drugs. The treatment of CH with antiepileptic drugs should be prescribed by neurologists who are familiar with these drugs and their side-effects. Combination of pharmacological drugs can be used for the chronic type of CH and for the prophylactic treatment. Surgical management is recommended only for chronic CH that has become resistant to the pharmacological treatment. The surgical treatment is directed either to the autonomic pathways or to the sensory trigeminal nerve.
KEY WORDS: Headache, Cluster headache, Horton's syndrome, Episodic cluster headache, Chronic cluster headache.
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