In honor of National Migraine and Headache Awareness Month, the National Headache Foundation has released information on cluster headache, which has been described as one of the most painful types of headaches. Cluster headache can be misdiagnosed as a sinus headache but is a neurological disorder with excruciating pain that may lead to suicidal ideation. Triggers include alcohol, nitroglycerine, or histamine, but the cause can be very complex and is generally not well understood.

Prophylactic therapy for patients with episodic cluster headaches may help shorten the length and reduce the severity of the headaches. Medications such as corticosteroids, verapamil, and antiepileptic drugs (eg, divalproex sodium, topiramate) are commonly used for prophylaxis and may be discontinued if the headaches stop occurringSome patients, however, may have chronic cluster headaches; lithium or calcium channel blockers are often used in these cases. For cases that do not respond to standard treatment, histamine desensitization and surgical intervention may be considered.

The most effective and safest treatment is pure 100% oxygen administered at the first signs of attack; many patients use a small oxygen tank at home and work when cluster headaches occur. If taken immediately, cluster headaches may respond to ergotamine preparations. Sumatriptan injection, a selective 5-HT1B/1D receptor agonist, is FDA-approved for the acute treatment of cluster headaches.

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