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Source: Minor DS, Harrell T. Headache disorders. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey L, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. https://accesspharmacy.mhmedical.com/content.aspx?bookid=1861§ionid=146063736. Accessed September 11, 2018.
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Most severe of the primary headache disorders, known as trigeminal autonomic cephalalgia
Classified by attacks of excruciating, unilateral head pain that occurs in series lasting for weeks or months (ie, cluster periods) separated by remission periods usually lasting months or years
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Exact prevalence is uncertain.
Estimated lifetime prevalence of 124 per 100,000 people or 0.12%
Male to female ratio is approximately 4:1 with the age onset typically in the third to fifth decade.
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Pathophysiologic mechanisms are not completely understood.
Neuroimaging studies performed during acute attacks have shown activation of the ipsilateral hypothalamic gray area, implicating the hypothalamus as a modulator of cluster headaches.
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CLINICAL PRESENTATION
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One hallmark of cluster headaches is the circadian rhythm of painful attacks.
Episodic cluster headaches are the most common cluster headache subtype.
Attacks occur daily for a week to several months, followed by pain-free intervals.
Average remission periods are 2 years in length.
Attacks occur commonly at night and more commonly in the spring and fall.
Attacks occur suddenly, pain peaks quickly after onset and lasts 15–180 min.
Pain presentation
Excruciating
Penetrating
Boring intensity in the orbital, supraorbital, and temporal unilateral locations
Auras are not present with cluster headaches.
Cranial autonomic symptoms
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TREATMENT: ABORTIVE THERAPY
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