«Մասնակից:Yeggarik/Ավազարկղ 2»–ի խմբագրումների տարբերություն

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Ջնջվում է էջի ամբողջ պարունակությունը
Պիտակ՝ Դատարկում
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Տող 1.
{{Use dmy dates|date=July 2013}}
{{Տեղեկաքարտ Հիվանդություն
| անվանում = Փնջային գլխացավ
| պատկեր = Gray778.png
| նկարագրում = [[Եռվորյակ նյարդ]]
| մասնագիտություն = [[Նյարդաբանություն]]
| ախտանիշ = Կրկնվող, սուր [[գլխացավ|գլխացավեր]] գլխի մի կողմում, արցունքահոսություն, քթի փակվածություն, քթահոսություն<ref name=Nesbitt2012/>
| սկիզբը = 20-40 տարեկան հասակում<ref name=AFP2013/>
| տևողություն = 15 րոպեից մինչև 3 ժամ<ref name=AFP2013/>
| տեսակ = էպիզոդիկ, քրոնիկ<ref name=AFP2013/>
| պատճառ = անհայտ է<ref name=AFP2013/>
| ռիսկ = [[Ծխախոտի_ազդեցությունն_առողջության_վրա|ծխելը]], ընտանեկան պատմությունը<ref name=AFP2013/>
| ախտորոշում = Ախտանիշների հիման վրա<ref name=AFP2013/>
| տարբերակում = [[Միգրեն]], [[Եռվորյակ նյարդի նևրալգիա]],<ref name=AFP2013/> այլ տրիգեմինալ ավտոնոմ ցեֆալգիաներ<ref>{{cite journal|last1=Rizzoli|first1=P|last2=Mullally|first2=WJ|title=Headache.|journal=The American Journal of Medicine|date=20 September 2017|doi=10.1016/j.amjmed.2017.09.005|pmid=28939471|volume=131|issue=1|pages=17–24}}</ref>
| կանխարգելում = Ստերոիդ հորմոններ, Վերապամիլ<ref name=Rob2016/>
| բուժում= Մաքուր թթվածին, Տրիպտաններ<ref name=AFP2013/><ref name=Rob2016/>
| medication =
| prognosis =
| հաճախություն = ~0.1%<ref name=Fis2008/>
| deaths =
}}
<!-- Definition and symptoms -->
'''Cluster headache''' ('''CH''') is a [[neurological disorder]] characterized by recurrent severe [[headache]]s on one side of the head, typically around the eye.<ref name=Nesbitt2012/> There is often accompanying eye watering, [[nasal congestion]], or swelling around the eye on the affected side.<ref name=Nesbitt2012>{{cite journal |doi=10.1136/bmj.e2407 |pmid=22496300 |title=Cluster headache |journal=BMJ |volume=344 |pages=e2407 |year=2012 |last1=Nesbitt |first1=A. D. |last2=Goadsby |first2=P. J. }}</ref> These symptoms typically last 15 minutes to 3 hours.<ref name=AFP2013/> Attacks often occur in clusters which typically last for weeks or months and occasionally more than a year.<ref name=AFP2013/>
 
<!-- Cause and diagnosis -->
The cause is unknown.<ref name=AFP2013/> Risk factors include a history of exposure to [[tobacco smoke]] and a family history of the condition.<ref name=AFP2013/> Exposures which may trigger attacks include [[ethanol|alcohol]], [[nitroglycerin (medication)|nitroglycerin]], and [[histamine]].<ref name=AFP2013/> They are a [[primary headache disorder]] of the [[trigeminal autonomic cephalalgia]]s type.<ref name=AFP2013/> Diagnosis is based on symptoms.<ref name=AFP2013/>
 
<!--Treatment and prevention -->
Recommended management includes lifestyle changes such as avoiding potential triggers.<ref name=AFP2013/> Treatments for acute attacks include [[oxygen]] or a fast-acting [[triptan]].<ref name=AFP2013>{{cite journal |pmid=23939643 |url=http://www.aafp.org/link_out?pmid=23939643 |year=2013 |last1=Weaver-Agostoni |first1=J |title=Cluster headache |journal=American Family Physician |volume=88 |issue=2 |pages=122–8 }}</ref><ref name=Rob2016>{{cite journal |doi=10.1111/head.12866 |pmid=27432623 |title=Treatment of Cluster Headache: The American Headache Society Evidence-Based Guidelines |journal=Headache |volume=56 |issue=7 |pages=1093–106 |year=2016 |last1=Robbins |first1=Matthew S. |last2=Starling |first2=Amaal J. |last3=Pringsheim |first3=Tamara M. |last4=Becker |first4=Werner J. |last5=Schwedt |first5=Todd J. }}</ref> Measures recommended to decrease the frequency of attacks include [[steroid injections]], [[civamide]], or [[verapamil]].<ref name=Rob2016/><ref name=Gaul11>{{cite journal |last1=Gaul |first1=C |last2=Diener |first2=H |last3=Müller |first3=OM |year=2011 |title=Cluster Headache Clinical Features and Therapeutic Options |journal=Deutsches Ärzteblatt International. Review |volume=108 |issue=33 |pages=543–549 |doi=10.3238/arztebl.2011.0543 |pmid=21912573 |pmc=3167933}}</ref> [[Nerve stimulation]] or surgery may occasionally be used if other measures are not effective.<ref name=AFP2013/>
 
<!-- Epidemiology, history, and culture -->
The condition affects about 0.1% of the general population at some point in their life and 0.05% in any given year.<ref name=Fis2008/> The condition usually first occurs between 20 and 40 years of age.<ref name=AFP2013/> Men are affected about four times more often than women.<ref name=Fis2008>{{cite journal |doi=10.1111/j.1468-2982.2008.01592.x |pmid=18422717 |title=The Incidence and Prevalence of Cluster Headache: A Meta-Analysis of Population-Based Studies |journal=Cephalalgia |volume=28 |issue=6 |pages=614–8 |year=2008 |last1=Fischera |first1=M |last2=Marziniak |first2=M |last3=Gralow |first3=I |last4=Evers |first4=S }}</ref> Cluster headaches are named for the occurrence of groups of headache attacks (clusters).<ref name=Nesbitt2012/> They have also been referred to as "suicide headaches".<ref name=AFP2013/>
 
==Signs and symptoms==
Cluster headaches are recurring bouts of severe unilateral headache attacks.<ref name=Beck>{{cite journal |vauthors=Beck E, Sieber WJ, Trejo R |title=Management of cluster headache |journal=Am Fam Physician |volume=71 |issue=4 |pages=717–24 |date=February 2005 |pmid=15742909 |url=http://www.aafp.org/afp/2005/0215/p717.html |type=Review |url-status=live |archiveurl=https://web.archive.org/web/20151113055721/http://www.aafp.org/afp/2005/0215/p717.html |archivedate=13 November 2015 |df=dmy-all }}</ref><ref name="pmid16628535">{{cite journal |doi=10.1055/s-2006-939925 |pmid=16628535 |title=Diagnosis and Treatment of Cluster Headache |journal=Seminars in Neurology |volume=26 |issue=2 |pages=242–59 |year=2006 |last1=Capobianco |first1=David |last2=Dodick |first2=David }}</ref> The duration of a typical CH attack ranges from about 15 to 180 minutes.<ref name=AFP2013/> About 75% of untreated attacks last less than 60 minutes.<ref name=EM2009>{{cite journal |doi=10.1016/j.emc.2008.09.005 |pmid=19218020 |pmc=2676687 |title=Diagnosis and Management of the Primary Headache Disorders in the Emergency Department Setting |journal=Emergency Medicine Clinics of North America |volume=27 |issue=1 |pages=71–87, viii |year=2009 |last1=Friedman |first1=Benjamin Wolkin |last2=Grosberg |first2=Brian Mitchell }}</ref> However, females may have longer and more severe CH.<ref name=CHandM2019>{{cite journal |authors=Vollesen AL, Benemei S, Cortese F, Labastida-Ramírez A, Marchese F, Pellesi L, Romoli M, Ashina M, Lampl C; School of Advanced Studies of the European Headache Federation (EHF-SAS).|title=Migraine and cluster headache - the common link. |date=2018 |journal=J Headache Pain. |doi=10.1186/s10194-018-0909-4}}</ref>
 
The onset of an attack is rapid and typically without an [[Aura (symptom)|aura]]. Preliminary sensations of pain in the general area of attack, referred to as "shadows", may signal an imminent CH, or these symptoms may linger after an attack has passed, or between attacks.<ref>{{cite journal |doi=10.1177/0333102410372423 |pmid=20974600 |title=Interictal pain in cluster headache |journal=Cephalalgia |volume=30 |issue=12 |pages=1531–4 |year=2010 |last1=Marmura |first1=Michael J |last2=Pello |first2=Scott J |last3=Young |first3=William B }}</ref> Though CH is strictly unilateral, there are some documented cases of "side-shift" between cluster periods,<ref>{{cite journal |doi=10.1007/s10194-009-0129-z |pmid=19495933 |pmc=3451747 |title=Lateralization in cluster headache: A Nordic multicenter study |journal=The Journal of Headache and Pain |volume=10 |issue=4 |pages=259–63 |year=2009 |last1=Meyer |first1=Eva Laudon |last2=Laurell |first2=Katarina |last3=Artto |first3=Ville |last4=Bendtsen |first4=Lars |last5=Linde |first5=Mattias |last6=Kallela |first6=Mikko |last7=Tronvik |first7=Erling |last8=Zwart |first8=John-Anker |last9=Jensen |first9=Rikke M. |last10=Hagen |first10=Knut }}</ref> or, rarely, simultaneous (within the same cluster period) bilateral cluster headaches.<ref>{{cite journal |pmid=11839832 |title=Cluster headache: A prospective clinical study with diagnostic implications |journal=Neurology |volume=58 |issue=3 |pages=354–61 |year=2002 |last1=Bahra |first1=A |last2=May |first2=A |last3=Goadsby |first3=PJ |df=dmy-all |doi=10.1212/wnl.58.3.354}}</ref>
 
===Pain===
The pain occurs only on one side of the head, around the eye, particularly above the eye, in the temple. The pain is typically greater than in other headache conditions, including [[migraine]]s. The pain is typically described as burning, stabbing, drilling or squeezing, and may be located near or behind the eye.<ref name="MehtaMaloney2011">{{cite book|author1=Noshir Mehta|author2=George E. Maloney|author3=Dhirendra S. Bana|author4=Steven J. Scrivani|title=Head, Face, and Neck Pain Science, Evaluation, and Management: An Interdisciplinary Approach|url=https://books.google.com/books?id=hgzeUKoeaTcC&pg=PT199|date=20 September 2011|publisher=John Wiley & Sons|isbn=978-1-118-20995-0|pages=199–|url-status=live|archiveurl=https://web.archive.org/web/20170214214959/https://books.google.com/books?id=hgzeUKoeaTcC&pg=PT199|archivedate=14 February 2017|df=dmy-all}}</ref> As a result of the pain, those with cluster headaches may experience suicidal thoughts during an attack (giving the alternative name "suicide headache" or "suicidal headache").<ref name=Rob2013/><ref>{{cite book|title=The 5-Minute Sports Medicine Consult|date=2012|publisher=Lippincott Williams & Wilkins|isbn=9781451148121|page=87|edition=2|url=https://books.google.com/books?id=-LOm9enAxQ8C&pg=PA87|url-status=live|archiveurl=https://web.archive.org/web/20170910172156/https://books.google.com/books?id=-LOm9enAxQ8C&pg=PA87|archivedate=10 September 2017|df=dmy-all}}</ref> It is reported as one of the most painful conditions.<ref>{{cite journal |doi=10.1586/14737175.4.5.895 |pmid=15853515 |title=Cluster headache: Focus on emerging therapies |journal=Expert Review of Neurotherapeutics |volume=4 |issue=5 |pages=895–907 |year=2014 |last1=Matharu |first1=Manjit S |last2=Goadsby |first2=Peter J }}</ref>
 
===Other symptoms===
The typical symptoms of cluster headache include grouped occurrence and recurrence (cluster) of headache attack, severe unilateral orbital, supraorbital and/or temporal pain. If left untreated, attack frequency may range from one attack every two days to eight attacks per day.<ref name=AFP2013/><ref name=IHS/> Cluster headache attack is accompanied by at least one of the following autonomic symptoms: [[Ptosis (eyelid)|drooping eyelid]], [[miosis|pupil constriction]], redness of the [[conjunctiva]], [[lacrimation|tearing]], [[rhinorrhea|runny nose]] and less commonly, [[facial blushing]], swelling, or sweating, typically appearing on the same side of the head as the pain.<ref name=IHS/>
 
Restlessness (for example, pacing or rocking back and forth) may occur. Similar to a migraine, sensitivity to light ([[photophobia]]) or noise ([[phonophobia]]) may occur during a CH. Nausea is a rare symptom although it has been reported.<ref name=Beck/> Secondary effects may include inability to organize thoughts and plans, physical exhaustion, confusion, agitation, aggressiveness, depression and anxiety.<ref name="Rob2013"/>
 
People with CH may dread facing another headache and adjust their physical or social activities around a possible future occurrence. Likewise they may seek assistance to accomplish what would otherwise be normal tasks. They may hesitate to make plans because of the regularity, or conversely, the unpredictability of the pain schedule. These factors can lead to generalized anxiety disorders, panic disorder,<ref name="Rob2013"/> serious depressive disorders,<ref>{{cite journal |doi=10.1177/0333102412469738 |pmid=23212294 |title=Cluster headache is associated with an increased risk of depression: A nationwide population-based cohort study |journal=Cephalalgia |volume=33 |issue=3 |pages=182–9 |year=2012 |last1=Liang |first1=Jen-Feng |last2=Chen |first2=Yung-Tai |last3=Fuh |first3=Jong-Ling |last4=Li |first4=Szu-Yuan |last5=Liu |first5=Chia-Jen |last6=Chen |first6=Tzeng-Ji |last7=Tang |first7=Chao-Hsiun |last8=Wang |first8=Shuu-Jiun }}</ref> social withdrawal and isolation.<ref>{{cite journal |doi=10.1111/j.1468-2982.2007.01330.x |pmid=17459083 |title=Burden of Cluster Headache |journal=Cephalalgia |volume=27 |issue=6 |pages=535–41 |year=2016 |last1=Jensen |first1=RM |last2=Lyngberg |first2=A |last3=Jensen |first3=RH }}</ref>
 
===Recurrence===
Cluster headaches may occasionally be referred to as "alarm clock headache" because of the regularity of their recurrence. CH attacks often awaken individuals from sleep. Both individual attacks and the cluster grouping can have a metronomic regularity; attacks typically striking at a precise time of day each morning or night. The recurrence of headache cluster grouping may occur more often around solstices, or seasonal changes, sometimes showing circannual periodicity. Conversely, attack frequency may be highly unpredictable, showing no periodicity at all. These observations have prompted researchers to speculate an involvement, or dysfunction of the hypothalamus. The hypothalamus controls the body's "biological clock" and [[circadian rhythm]].<ref>{{cite journal |doi=10.1017/S0317167100001694 |pmid=11858532 |title=Cluster Headache: Evidence for a Disorder of Circadian Rhythm and Hypothalamic Function |journal=The Canadian Journal of Neurological Sciences |volume=29 |issue=1 |pages=33–40 |year=2014 |last1=Pringsheim |first1=Tamara }}</ref><ref>{{cite journal |doi=10.1046/j.1526-4610.2003.03055.x |pmid=12603650 |title=Clinical, Anatomical, and Physiologic Relationship Between Sleep and Headache |journal=Headache: The Journal of Head and Face Pain |volume=43 |issue=3 |pages=282–92 |year=2003 |last1=Dodick |first1=David W. |last2=Eross |first2=Eric J. |last3=Parish |first3=James M. }}</ref> In episodic cluster headache, attacks occur once or more daily, often at the same time each day for a period of several weeks, followed by a headache-free period lasting weeks, months, or years. Approximately 10–15% of cluster headaches are [[Chronic (medicine)|chronic]], with multiple headaches occurring every day for years, sometimes without any remission.<ref name="NHS">{{cite web |url=https://www.nhs.uk/conditions/cluster-headaches/ |title=Cluster headaches:Pattern of attacks |author=<!--Not stated--> |date=May 22, 2017 |website=NHS|publisher=Gov.UK |access-date= December 13, 2018}}</ref>
 
In accordance with the International Headache Society (IHS) diagnostic criteria, cluster headaches occurring in two or more cluster periods, lasting from 7 to 365 days with a pain-free remission of one month or longer between the headache attacks, may be classified as episodic. If headache attacks occur for more than a year without pain-free remission of at least one month, the condition is classified as chronic.<ref name=IHS>{{cite web |url= http://www.ihs-classification.org/en/02_klassifikation/02_teil1/03.01.00_cluster.html |title= IHS Classification ICHD-II 3.1 Cluster headache |publisher= The International Headache Society |accessdate= 2014-01-03 |url-status= dead |archiveurl= https://web.archive.org/web/20131103182003/http://www.ihs-classification.org/en/02_klassifikation/02_teil1/03.01.00_cluster.html |archivedate= 3 November 2013 |df= dmy-all }}</ref>
Chronic CH both occurs and recurs without any remission periods between cycles; there may be variation in cycles, meaning the frequency and severity of attacks may change without predictability for a period of time. The frequency, severity and duration of headache attacks experienced by people during these cycles varies between individuals and does not demonstrate complete remission of the episodic form. The condition may change unpredictably from chronic to episodic and from episodic to chronic.<ref>{{cite journal |doi=10.1007/s11916-002-0026-5 |pmid=11749880 |title=What predicts evolution from episodic to chronic cluster headache? |journal=Current Pain and Headache Reports |volume=6 |issue=1 |pages=65–70 |year=2002 |last1=Torelli |first1=Paola |last2=Manzoni |first2=Gian Camillo }}</ref>
 
==Causes==
{| class="wikitable floatright"
|-
| [[Image:PET1.jpg|center|150x150px]] || [[Image:PET2.jpg|center|150x150px]] || [[Image:PET3.jpg|center|150x150px]]
|-
| colspan="3" style="text-align:center;"| ''[[Positron emission tomography]] (PET) shows brain areas being activated during pain''
|-
| [[Image:VBM1.jpg|center|150x150px]] || [[Image:VBM2.jpg|center|150x150px]] || [[Image:VBM3.jpg|center|150x150px]]
|-
| colspan="3" style="text-align:center;"| ''[[Voxel-based morphometry]] (VBM) shows brain area structural differences''
|}
The cause of cluster headache is unknown.<ref name=Pinessi2005>{{cite journal |doi=10.1007/s10194-005-0194-x |pmid=16362673 |pmc=3452030 |title=Genetics of cluster headache: An update |journal=The Journal of Headache and Pain |volume=6 |issue=4 |pages=234–6 |year=2005 |last1=Pinessi |first1=L. |last2=Rainero |first2=I. |last3=Rivoiro |first3=C. |last4=Rubino |first4=E. |last5=Gallone |first5=S. }}</ref> Cluster headaches were historically described as [[vascular headache]]s, with the belief that intense pain was caused by [[Vasodilation|dilation of blood vessels]] which in turn, was thought to create pressure on the [[trigeminal nerve]]. The vascular theory has been called into question <ref>{{cite journal |doi=10.1093/brain/awn321 |pmid=19098031 |title=The vascular theory of migraine—a great story wrecked by the facts |journal=Brain |volume=132 |issue=Pt 1 |pages=6–7 |year=2009 |last1=Goadsby |first1=Peter J. }}</ref> and other mechanisms are being considered.<ref>{{cite journal |doi=10.1007/s10072-013-1365-1 |pmid=22193419 |title=Cluster headache: What has changed since 1999? |journal=Neurological Sciences |volume=34 |issue=1 |pages=71–4 |year=2013 |last1=Leone |first1=Massimo |last2=Cecchini |first2=Alberto Proietti |last3=Tullo |first3=Vincenzo |last4=Curone |first4=Marcella |last5=Di Fiore |first5=Paola |last6=Bussone |first6=Gennaro }}</ref> The Third Edition of the Internal Classification of Headache disorders classifies CH as belonging to the trigeminal autonomic cephalalgias.<ref>{{cite journal |author=Headache Classification Committee of the International Headache Society (IHS) |date=2013 |title=The International Classification of Headache Disorders, 3rd edition (beta version) |journal=Cephalalgia |volume=33 |issue=9 |pages=629–808 |doi=10.1177/0333102413485658 |pmid=23771276|url=https://www.zora.uzh.ch/id/eprint/89115/1/89115.pdf }}</ref>
 
===Genetics===
Cluster headache may, but rarely, run in some families in an [[autosomal dominant]] inheritance pattern.<ref name=Pinessi2005 /> People with a [[Consanguinity|first degree relative]] with the condition are about 14–48 times more likely to develop it themselves,<ref name=Nesbitt2012 /> and between 1.9 and 20% of persons with CH have a positive family history.<ref name=Pinessi2005 /> Possible genetic factors warrant further research, current evidence for genetic inheritance is limited.<ref name=Pinessi2005 />
 
===Tobacco smoking===
About 65% of persons with CH are, or have been, tobacco smokers.<ref name=Nesbitt2012 /> Stopping smoking does not lead to improvement of the condition and CH also occurs in those who have never smoked (e.g. children);<ref name=Nesbitt2012 /> it is thought unlikely that smoking is a cause.<ref name=Nesbitt2012 /> People with CH may be predisposed to certain traits, including smoking or other lifestyle habits.<ref name="pmid18474191">{{cite journal |doi=10.1007/s11916-008-0022-5 |pmid=18474191 |title=Cluster headache and lifestyle habits |journal=Current Pain and Headache Reports |volume=12 |issue=2 |pages=115–21 |year=2008 |last1=Schürks |first1=Markus |last2=Diener |first2=Hans-Christoph }}</ref>
 
===Hypothalamus===
A review suggests that the [[suprachiasmatic nucleus]] of the [[hypothalamus]], which is the major biological clock in the human body, may be involved in cluster headaches, because CH occurs with diurnal and seasonal rhythmicity.<ref>{{cite journal |last=Pringsheim |first=Tamara |title=Cluster headache: evidence for a disorder of circadian rhythm and hypothalamic function |journal=Canadian Journal of Neurological Sciences |date=February 2002 |volume=29 |issue=1 |pages=33–40 |doi=10.1017/S0317167100001694 |pmid=11858532}}</ref> A drop in RBC choline levels has also been reported during an attack.<ref name="pmid6519980">{{cite journal | vauthors = de Belleroche J, Clifford Rose F, Das I, Cook GE | title = Metabolic abnormality in cluster headache | journal = Headache | volume = 24 | issue = 6 | pages = 310–2 | date = November 1984 | pmid = 6519980 | doi = 10.1111/j.1526-4610.1984.hed2406310.x}}</ref>
 
[[Positron emission tomography]] (PET) scans indicate the brain areas which are activated during attack only, compared to pain free periods. These pictures show brain areas which are active during pain in yellow/orange color (called "pain matrix"). The area in the center (in all three views) is specifically activated during CH only. The bottom row [[voxel-based morphometry]] (VBM) shows structural brain differences between individuals with and without CH; only a portion of the [[hypothalamus]] is different.<ref>{{cite journal |doi=10.1007/s11916-007-0010-1 |pmid=17367592 |title=Cluster headache: A review of neuroimaging findings |journal=Current Pain and Headache Reports |volume=11 |issue=2 |pages=131–6 |year=2007 |last1=Dasilva |first1=Alexandre F. M. |last2=Goadsby |first2=Peter J. |last3=Borsook |first3=David }}</ref>
 
==Diagnosis==
Cluster headaches are often misdiagnosed, mismanaged, or undiagnosed for many years; they may be confused with migraine, "cluster-like" headache (or mimics), CH subtypes, other TACs ( trigeminal autonomic cephalalgias), or other types of primary or secondary headache syndrome.<ref name=Vliet/> Cluster-like head pain may be diagnosed as secondary headache rather than cluster headache.<ref name=IHS/>
 
A detailed oral history aids practitioners in correct differential diagnosis, as there are no confirmatory tests for CH. A headache diary can be useful in tracking when and where pain occurs, how severe it is, and how long the pain lasts. A record of coping strategies used may help distinguish between headache type; data on frequency, severity and duration of headache attacks are a necessary tool for initial and correct differential diagnosis in headache conditions.<ref>{{cite web |url= http://www.nps.org.au/__data/assets/pdf_file/0010/160003/NPS_Headache_Diary_0612.pdf |title= Headache diary: helping you manage your headache |publisher= NPS.org.au |accessdate= 2014-01-02 |url-status= dead |archiveurl= https://web.archive.org/web/20130921054005/http://www.nps.org.au/__data/assets/pdf_file/0010/160003/NPS_Headache_Diary_0612.pdf |archivedate= 21 September 2013 |df= dmy-all }}</ref>
 
Correct diagnosis presents a challenge as the first CH attack may present where staff are not trained in the diagnosis of rare or complex chronic disease.<ref name="EM2009"/> Although experienced ER staff are sometimes trained to detect headache types,<ref>{{cite journal |doi=10.1136/jnnp.2004.057968 |pmid=16024902 |pmc=1739753 |title=Ability of a nurse specialist to diagnose simple headache disorders compared with consultant neurologists |journal=Journal of Neurology, Neurosurgery & Psychiatry |volume=76 |issue=8 |pages=1170–2 |year=2005 |last1=Clarke |first1=C E }}</ref> CH attacks themselves are not directly life-threatening, they are linked to an increased risk of suicide.<ref name=Rob2013>{{cite journal |doi=10.1007/s11916-012-0313-8 |title=The Psychiatric Comorbidities of Cluster Headache |journal=Current Pain and Headache Reports |volume=17 |issue=2 |year=2013 |last1=Robbins |first1=Matthew S.|pmid=23296640 |page=313}}</ref><ref>{{cite web |url=https://www.nlm.nih.gov/medlineplus/ency/article/000786.htm |title=Cluster headache |publisher=MedlinePlus Medical Encyclopedia |date=2012-11-02 |accessdate=2014-04-05 |url-status=live |archiveurl=https://web.archive.org/web/20140405112718/http://www.nlm.nih.gov/medlineplus/ency/article/000786.htm |archivedate=5 April 2014 |df=dmy-all }}</ref>
 
Individuals with CH typically experience [[diagnostic delay]] before correct diagnosis.<ref name=Vliet>{{cite journal |doi=10.1136/jnnp.74.8.1123 |pmid=12876249 |pmc=1738593 |title=Features involved in the diagnostic delay of cluster headache |journal=Journal of Neurology, Neurosurgery & Psychiatry |volume=74 |issue=8 |pages=1123–5 |year=2003 |last1=Van Vliet |first1=J A }}</ref><ref>{{cite journal |doi=10.1046/j.1600-0404.2003.00237.x |pmid=14763953 |title=Diagnostic delays and mis-management in cluster headache |journal=Acta Neurologica Scandinavica |volume=109 |issue=3 |pages=175–9 |year=2004 |last1=Bahra |first1=A. |last2=Goadsby |first2=P. J. }}</ref> People are often misdiagnosed due to reported neck, tooth, jaw, and sinus symptoms and may unnecessarily endure many years of referral to [[Otolaryngologist|ear, nose and throat (ENT) specialists]] for investigation of sinuses; dentists for tooth assessment; [[chiropractor]]s and manipulative therapists for treatment; or [[psychiatrist]]s, [[psychologist]]s, and other medical disciplines before their headaches are correctly diagnosed.<ref name=Flanders>{{cite journal |pmid=19402567 |year=2009 |last1=Van Alboom |first1=E |title=Diagnostic and therapeutic trajectory of cluster headache patients in Flanders |journal=Acta Neurologica Belgica |volume=109 |issue=1 |pages=10–7 |last2=Louis |first2=P |last3=Van Zandijcke |first3=M |last4=Crevits |first4=L |last5=Vakaet |first5=A |last6=Paemeleire |first6=K }}</ref> Under-recognition of CH by health care professionals is reflected in consistent findings in Europe and the United States that the average time to diagnosis is around seven years.<ref name=Tfelt-Hansen2012 />
===Differential===
Cluster headache may be misdiagnosed as migraine or [[sinusitis]].<ref name=Tfelt-Hansen2012>{{cite journal |doi=10.2165/11632850-000000000-00000 |pmid=22650381 |title=Management of Cluster Headache |journal=CNS Drugs |volume=26 |issue=7 |pages=571–80 |year=2012 |last1=Tfelt-Hansen |first1=Peer C. |last2=Jensen |first2=Rigmor H. }}</ref> Other types of headache are sometimes mistaken for, or may mimic closely, CH. Incorrect terms like "cluster migraine" confuse headache types, confound differential diagnosis and are often the cause of unnecessary diagnostic delay,<ref>{{cite journal |doi=10.1046/j.1526-4610.2000.00127.x |pmid=11091291 |title=The Misdiagnosis of Cluster Headache: A Nonclinic, Population-Based, Internet Survey |journal=Headache |volume=40 |issue=9 |pages=730–5 |year=2000 |last1=Klapper |first1=Jack A. |last2=Klapper |first2=Amy |last3=Voss |first3=Tracy }}</ref> ultimately delaying appropriate specialist treatment.
 
Headaches that may be confused with CH include:
*[[Chronic paroxysmal hemicrania]] (CPH) is a unilateral headache condition, without the male predominance usually seen in CH. Paroxysmal hemicrania may also be episodic but the episodes of pain seen in CPH are usually shorter than those seen with cluster headaches. CPH typically responds "absolutely" to treatment with the [[anti-inflammatory]] drug [[indomethacin]]<ref name=IHS/> where in most cases CH typically shows no positive indomethacin response, making "Indomethacin response" an important diagnostic tool for specialist practitioners seeking correct differential diagnosis between the conditions.<ref>{{cite journal |doi=10.1177/0333102409357642 |pmid=20656709 |title=Cluster headache responsive to indomethacin: Case reports and a critical review of the literature |journal=Cephalalgia |volume=30 |issue=8 |pages=975–82 |year=2010 |last1=Prakash |first1=Sanjay |last2=Shah |first2=Nilima D |last3=Chavda |first3=Bhavna V }}</ref><ref>{{cite journal |pmid=20626997 |year=2010 |last1=Sjaastad |first1=O |title=Indomethacin responsive headache syndromes: Chronic paroxysmal hemicrania and Hemicrania continua. How they were discovered and what we have learned since |journal=Functional Neurology |volume=25 |issue=1 |pages=49–55 |last2=Vincent |first2=M }}</ref>
* [[Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing]] (SUNCT) is a headache syndrome belonging to the group of TACs.<ref name=IHS/><ref name="Rizzoli2017">{{cite journal|last1=Rizzoli|first1=P|last2=Mullally|first2=WJ|title=Headache|journal=American Journal of Medicine|date=September 2017|volume=S0002-9343|issue=17|pages=30932–4|doi=10.1016/j.amjmed.2017.09.005|pmid=28939471|type=Review}}</ref>
* [[Trigeminal neuralgia]] is a unilateral headache syndrome,<ref name=Flanders/> or "cluster-like" headache.<ref>{{cite journal |doi=10.1177/2049463712456355 |pmid=26516482 |pmc=4590147 |title=Trigeminal autonomic cephalgias |journal=British Journal of Pain |volume=6 |issue=3 |pages=106–23 |year=2012 |last1=Benoliel |first1=Rafael }}</ref>
 
==Prevention==
Preventive treatments are used to reduce or eliminate cluster headache attacks; they are generally used in combination with abortive and transitional techniques.<ref name=Beck />
 
===Verapamil===
The recommended first-line preventive therapy is [[verapamil]], a [[calcium channel blocker]].<ref name=AFP2013/><ref name=EFNS>{{cite journal |doi=10.1111/j.1468-1331.2006.01566.x |pmid=16987158 |title=EFNS guidelines on the treatment of cluster headache and other trigeminal-autonomic cephalalgias |journal=European Journal of Neurology |volume=13 |issue=10 |pages=1066–77 |year=2006 |last1=May |first1=A. |last2=Leone |first2=M. |last3=Áfra |first3=J. |last4=Linde |first4=M. |last5=Sándor |first5=P. S. |last6=Evers |first6=S. |last7=Goadsby |first7=P. J. }}</ref> Verapamil was previously underused in people with cluster headache.<ref name=Beck/>
 
===Glucocorticoids===
There is little evidence to support a long-term benefit from [[glucocorticoid]]s,<ref name=AFP2013/> but they may be used until other medications take effect as they appear to be effective at three days.<ref name=AFP2013/> They are generally discontinued after 8–10 days of treatment.<ref name=Beck/>
 
===Surgery===
Nerve stimulators may be an option in the small number of people who do not improve with medications.<ref>{{cite book |doi=10.1159/000323045 |pmid=21422783 |chapter=Peripheral Nerve Stimulation in Chronic Cluster Headache |title=Peripheral Nerve Stimulation |volume=24 |pages=126–32 |series=Progress in Neurological Surgery |year=2011 |last1=Magis |first1=Delphine |last2=Schoenen |first2=Jean |isbn=978-3-8055-9489-9 }}</ref><ref name=EU2013>{{cite journal |doi=10.1186/1129-2377-14-86 |title=Neuromodulation of chronic headaches: Position statement from the European Headache Federation |journal=The Journal of Headache and Pain |volume=14 |year=2013 |last1=Martelletti |first1=Paolo |last2=Jensen |first2=Rigmor H |last3=Antal |first3=Andrea |last4=Arcioni |first4=Roberto |last5=Brighina |first5=Filippo |last6=De Tommaso |first6=Marina |last7=Franzini |first7=Angelo |last8=Fontaine |first8=Denys |last9=Heiland |first9=Max |last10=Jürgens |first10=Tim P |last11=Leone |first11=Massimo |last12=Magis |first12=Delphine |last13=Paemeleire |first13=Koen |last14=Palmisani |first14=Stefano |last15=Paulus |first15=Walter |last16=May |first16=Arne |page=86 |pmc=4231359 |pmid=24144382}}</ref> Two procedures, [[deep brain stimulation]] or [[occipital nerve stimulation]], may be useful;<ref name=AFP2013/> early experience shows a benefit in about 60% of cases.<ref>{{cite journal |doi=10.1097/wco.0b013e32832ae61e |pmid=19434793 |title=Neurostimulation approaches to primary headache disorders |journal=Current Opinion in Neurology |volume=22 |issue=3 |pages=262–8 |year=2009 |last1=Bartsch |first1=Thorsten |last2=Paemeleire |first2=Koen |last3=Goadsby |first3=Peter J }}</ref> It typically takes weeks or months for this benefit to appear.<ref name=EU2013/> A non-invasive method using [[transcutaneous electrical nerve stimulation]] (TENS) is being studied.<ref name=EU2013/>
 
A number of surgical procedures, such as a [[rhizotomy]] or [[microvascular decompression]], may also be considered,<ref name=EU2013/> but evidence to support them is limited and there are cases of people whose symptoms worsen after these procedures.<ref name=EU2013/>
 
===Other===
[[Lithium (medication)|Lithium]], [[methysergide]], and [[topiramate]] are recommended alternative treatments,<ref name=EFNS/><ref>{{cite journal |doi=10.1517/14656566.2010.496454 |pmid=20569084 |title=Pharmacotherapy of cluster headache |journal=Expert Opinion on Pharmacotherapy |volume=11 |issue=13 |pages=2121–7 |year=2010 |last1=Evers |first1=Stefan }}</ref> although there is little evidence supporting the use of topiramate or methysergide.<ref name=AFP2013/><ref name=CE2010>{{cite journal|author=Matharu M|title=Cluster headache|journal=Clinical Evidence|date=Feb 9, 2010|volume=2010|pmid=21718584|type= Review|pmc=2907610}}</ref> This is also true for [[tianeptine]], [[melatonin]], and [[ergotamine]].<ref name=AFP2013/> [[Valproate]], [[sumatriptan]], and [[oxygen]] are not recommended as preventive measures.<ref name=AFP2013/> [[Botulinum toxin]] injections have shown limited success.<ref>{{cite journal |doi=10.1007/s11916-009-0028-7 |pmid=19272284 |title=The role of nerve blocks and botulinum toxin injections in the management of cluster headaches |journal=Current Pain and Headache Reports |volume=13 |issue=2 |pages=164–7 |year=2009 |last1=Ailani |first1=Jessica |last2=Young |first2=William B. }}</ref> Evidence for [[baclofen]], [[botulinum toxin]], and [[capsaicin]] is unclear.<ref name=CE2010/>
 
==Management==
Treatment for cluster headache is divided into three primary categories: abortive, transitional, and preventive.<ref name=Nal2012>{{cite book|author1=Nalini Vadivelu|author2=Alan David Kaye|author3=Jack M. Berger|title=Essentials of palliative care|publisher=Springer|location=New York, NY|isbn=9781461451648|page=335|url=https://books.google.com/books?id=hGBSe3r_VDUC&pg=PA335|date=2012-11-28|url-status=live|archiveurl=https://web.archive.org/web/20170910172156/https://books.google.com/books?id=hGBSe3r_VDUC&pg=PA335|archivedate=10 September 2017|df=dmy-all}}</ref> There are two primary treatments for acute CH: [[oxygen]] and [[triptan]]s,<ref name=AFP2013/> but they are underused due to misdiagnosis of the syndrome.<ref name=Beck/> During bouts of headaches, triggers such as [[alcohol (drug)|alcohol]], [[nitroglycerine]] and naps during the day should be avoided.<ref name=EM2009/>
 
===Oxygen===
[[Oxygen therapy]] may help people with CH, but it does not help prevent future episodes.<ref name=AFP2013 /> Typically it is given via a [[non-rebreather mask]] at 12–15 liters per minute for 15–20 minutes.<ref name=AFP2013 /> One review found about 70% improve within 15 minutes.<ref name=EM2009 /> The evidence for effectiveness of 100% oxygen, however, is weak.<ref name="EM2009"/><ref name=pmid26709672>{{cite book |doi=10.1002/14651858.CD005219.pub3 |pmid=26709672 |chapter=Normobaric and hyperbaric oxygen therapy for the treatment and prevention of migraine and cluster headache |title=Cochrane Database of Systematic Reviews |journal=The Cochrane Database of Systematic Reviews |issue=12 |pages=CD005219 |year=2015 |last1=Bennett |first1=Michael H |last2=French |first2=Christopher |last3=Schnabel |first3=Alexander |last4=Wasiak |first4=Jason |last5=Kranke |first5=Peter |last6=Weibel |first6=Stephanie }}</ref> Hyperbaric oxygen at pressures of ~2 times greater than atmospheric pressure may relieve cluster headaches.<ref name=pmid26709672/>
 
===Triptans===
The other primarily recommended treatment of acute attacks is subcutaneous or intranasal [[sumatriptan]].<ref name=EFNS/> Sumatriptan and [[zolmitriptan]] have both been shown to improve symptoms during an attack with sumatriptan being superior.<ref name=Law2013>{{cite book |doi=10.1002/14651858.cd008042.pub3 |chapter=Triptans for acute cluster headache |title=Cochrane Database of Systematic Reviews |journal=The Cochrane Database of Systematic Reviews |issue=4 |pages=CD008042 |year=2013 |last1=Law |first1=Simon |last2=Derry |first2=Sheena |last3=Moore |first3=R Andrew |pmc=4170909 |pmid=20393964}}</ref> Because of the vasoconstrictive side-effect of triptans, they may be contraindicated in people with [[ischemic heart disease]].<ref name=AFP2013/>
 
===Opioids===
The use of [[opioid]] medication in management of CH is not recommended<ref name=Pae2008/> and may make headache syndromes worse.<ref>{{cite journal |doi=10.1177/0333102412467512 |pmid=23144180 |title=Medication-overuse headache and opioid-induced hyperalgesia: A review of mechanisms, a neuroimmune hypothesis and a novel approach to treatment |journal=Cephalalgia |volume=33 |issue=1 |pages=52–64 |year=2012 |last1=Johnson |first1=Jacinta L |last2=Hutchinson |first2=Mark R |last3=Williams |first3=Desmond B |last4=Rolan |first4=Paul |hdl=2440/78280 }}</ref><ref>{{cite journal |doi=10.1016/j.tips.2009.08.002 |pmid=19762094 |pmc=2783351 |title=The "Toll" of Opioid-Induced Glial Activation: Improving the Clinical Efficacy of Opioids by Targeting Glia |journal=Trends in Pharmacological Sciences |volume=30 |issue=11 |pages=581–91 |year=2009 |last1=Watkins |first1=Linda R. |last2=Hutchinson |first2=Mark R. |last3=Rice |first3=Kenner C. |last4=Maier |first4=Steven F. }}</ref> Long-term opioid use is associated with well known dependency, addiction, and withdrawal syndromes.<ref>{{cite journal |doi=10.1007/s40263-013-0081-y |pmid=23925669 |title=Medication Overuse Headache: History, Features, Prevention and Management Strategies |journal=CNS Drugs |volume=27 |issue=11 |pages=867–77 |year=2013 |last1=Saper |first1=Joel R. |last2=Da Silva |first2=Arnaldo Neves }}</ref> Prescription of opioid medication may additionally lead to further delay in differential diagnosis, undertreatment, and mismanagement.<ref name=Pae2008>{{cite journal |doi=10.1007/s11916-008-0023-4 |pmid=18474192 |title=Medication-overuse headache in patients with cluster headache |journal=Current Pain and Headache Reports |volume=12 |issue=2 |pages=122–7 |year=2008 |last1=Paemeleire |first1=Koen |last2=Evers |first2=Stefan |last3=Goadsby |first3=Peter J. }}</ref>
 
===Other===
The vasoconstrictor [[ergot]] compounds may be useful,<ref name=EM2009/> but have not been well studied in acute attacks.<ref name=Law2013/> [[Octreotide]] administered subcutaneously has been demonstrated to be more effective than placebo for the treatment of acute attacks.<ref>{{cite journal |pmid=21718584 |pmc=2907610 |year=2010 |last1=Matharu |first1=M |title=Cluster headache |journal=BMJ Clinical Evidence |volume=2010 }}</ref>
 
==Epidemiology==
Cluster headache affects about 0.1% of the general population at some point in their life.<ref name=Fis2008/> Males are affected about four times more often than females.<ref name=Fis2008/> The condition usually starts between the ages of 20 and 50 years, although it can occur at any age.<ref name=Nesbitt2012 /> About one in five of adults reports the onset of cluster headache between 10 and 19 years.<ref name="Abu-Arafeh2016">{{cite book|author1=Ishaq Abu-Arafeh|author2=Aynur Özge|title=Headache in Children and Adolescents: A Case-Based Approach|url=https://books.google.com/books?id=sf3cDAAAQBAJ&pg=PA62|date=2016|publisher=Springer International Publishing Switzerland|isbn=978-3-319-28628-0|pages=62–|url-status=live|archiveurl=https://web.archive.org/web/20170910172156/https://books.google.com/books?id=sf3cDAAAQBAJ&pg=PA62|archivedate=10 September 2017|df=dmy-all}}</ref>
 
==History==
The first complete description of cluster headache was given by the London neurologist [[Wilfred Harris]] in 1926, who named the disease ''migrainous neuralgia''.<ref>Harris W.: Neuritis and Neuralgia. p. 307-12. Oxford: Oxford University Press 1926.</ref><ref>{{cite journal |doi=10.1016/S0140-6736(59)90651-8 |title=The periodic migrainous neuralgia of Wilfred Harris |year=1959 |author=Bickerstaff E |journal=The Lancet |volume=273 |issue=7082 |pages=1069–71 |pmid=13655672 }}</ref><ref>{{cite journal |doi=10.1046/j.1468-2982.2002.00360.x |pmid=12100097 |title=Wilfred Harris' Early Description of Cluster Headache |journal=Cephalalgia |volume=22 |issue=4 |pages=320–6 |year=2016 |last1=Boes |first1=CJ |last2=Capobianco |first2=DJ |last3=Matharu |first3=MS |last4=Goadsby |first4=PJ }}</ref> Descriptions of CH date to 1745 and probably earlier.<ref>{{cite journal |doi=10.1136/jnnp.2007.123091 |pmid=17940171 |pmc=2117620 |title=Gerardi van Swieten: Descriptions of episodic cluster headache |journal=Journal of Neurology, Neurosurgery & Psychiatry |volume=78 |issue=11 |pages=1248–9 |year=2007 |last1=Pearce |first1=J M S }}</ref>
 
The condition was originally named Horton's cephalalgia after [[Bayard Taylor Horton]], a US neurologist who postulated the first theory as to their pathogenesis. His original paper describes the severity of the headaches as being able to take normal men and force them to attempt or complete suicide; his 1939 paper said:<blockquote>"Our patients were disabled by the disorder and suffered from bouts of pain from two to twenty times a week. They had found no relief from the usual methods of treatment. Their pain was so severe that several of them had to be constantly watched for fear of suicide. Most of them were willing to submit to any operation which might bring relief."<ref>{{cite journal |vauthors=Horton BT, MacLean AR, Craig WM |journal= Mayo Clinic Proceedings |year= 1939 |volume= 14 |page= 257 |title= A new syndrome of vascular headache: results of treatment with histamine: preliminary report}}</ref></blockquote>
 
CH has alternately been called erythroprosopalgia of Bing, ciliary neuralgia, [[erythromelalgia]] of the head, Horton's headache, histaminic cephalalgia, petrosal neuralgia, sphenopalatine neuralgia, vidian neuralgia, Sluder's neuralgia, Sluder's syndrome, and hemicrania angioparalyticia.<ref>{{cite book |vauthors=Silberstein SD, Lipton RB, Goadsby PJ |title= Headache in Clinical Practice |edition= Second |publisher= Taylor & Francis |year= 2002 }}{{page needed|date=July 2017}}</ref>
 
== Society and culture ==
Robert Shapiro, a professor of neurology, says that while cluster headaches are about as common as [[multiple sclerosis]] with a similar disability level, as of 2013, the US [[National Institutes of Health]] had spent $1.872 billion on research into multiple sclerosis in one decade, but less than $2 million on CH research in 25 years.<ref name=Unlocking>{{cite news |url= https://www.usatoday.com/story/news/nation/2013/05/16/researcher-unlocking-mysteries-migraines/2165363/ |title= Researcher works to unlock mysteries of migraines |author= Johnson, Tim |work= USA Today |date= May 16, 2013 |accessdate= January 4, 2013 |url-status= live |archiveurl= https://web.archive.org/web/20130517025701/http://www.usatoday.com/story/news/nation/2013/05/16/researcher-unlocking-mysteries-migraines/2165363/ |archivedate= 17 May 2013 |df= dmy-all }}</ref>
 
{{as of|July 2015}} there are no approved medicines for the prevention of cluster headache in the United States.<ref>{{cite press release |url=http://www.prnewswire.com/news-releases/lillys-investigational-medicine-for-prevention-of-migraine-met-primary-endpoint-in-a-phase-2b-study-300100695.html |accessdate=2015-06-18 |url-status=live |archiveurl=https://web.archive.org/web/20150618090927/http://www.prnewswire.com/news-releases/lillys-investigational-medicine-for-prevention-of-migraine-met-primary-endpoint-in-a-phase-2b-study-300100695.html |title=Lilly's investigational medicine for prevention of migraine met primary endpoint in a Phase 2b study |date=17 June 2015 |location=Indianapolis, Indiana |publisher=Eli Lilly and Company |archivedate=18 June 2015 |df=dmy-all }}</ref>
 
== Research directions ==
Some controversial case reports suggest that ingesting tryptamines such as [[LSD]], [[psilocybin]] (as found in hallucinogenic mushrooms), or [[N,N-Dimethyltryptamine|DMT]] can reduce pain and interrupt cluster headache cycles.<ref name=Sun2011>{{cite journal |doi=10.1111/j.1526-4610.2011.01846.x |pmid=21352222 |title=Alternative Headache Treatments: Nutraceuticals, Behavioral and Physical Treatments |journal=Headache |volume=51 |issue=3 |pages=469–83 |year=2011 |last1=Sun-Edelstein |first1=Christina |last2=Mauskop |first2=Alexander }}</ref><ref name=Vollenweider2010>{{cite journal |doi=10.1038/nrn2884 |pmid=20717121 |title=The neurobiology of psychedelic drugs: Implications for the treatment of mood disorders |journal=Nature Reviews Neuroscience |volume=11 |issue=9 |pages=642–51 |year=2010 |last1=Vollenweider |first1=Franz X. |last2=Kometer |first2=Michael }}</ref> A 2006 survey of 53 individuals found people said that psilocybin extended remission periods in 18 of 19. The survey was not a blinded or a controlled study, and was "limited by recall and selection bias".<ref name=Sun2011/> The safety and efficacy of psilocybin is currently being studied in cluster headache.<ref>{{Cite journal|last=Brandt|first=Roemer B.|last2=Doesborg|first2=Patty G. G.|last3=Haan|first3=Joost|last4=Ferrari|first4=Michel D.|last5=Fronczek|first5=Rolf|date=2020-02-01|title=Pharmacotherapy for Cluster Headache|url=https://doi.org/10.1007/s40263-019-00696-2|journal=CNS Drugs|language=en|volume=34|issue=2|pages=171–184|doi=10.1007/s40263-019-00696-2|issn=1179-1934}}</ref><ref>{{Cite web|url=https://clinicaltrials.gov/ct2/show/NCT02981173|title=Psilocybin for the Treatment of Cluster Headache - Full Text View - ClinicalTrials.gov|website=clinicaltrials.gov|language=en|access-date=2020-02-15}}</ref>
 
[[Fremanezumab]], a humanized [[monoclonal antibody]] directed against [[calcitonin gene-related peptide]]s alpha and beta, is in phase 3 clinical trials for CH.<ref>{{cite web |url=https://clinicaltrials.gov/ct2/show/NCT02964338 |title=A Study Comparing the Efficacy and Safety of TEV-48125 (Fremanezumab) for the Prevention of Chronic Cluster Headache (CCH) |website=ClinicalTrials.gov}}</ref><ref>{{cite web |url=https://clinicaltrials.gov/ct2/show/NCT02945046 |title=A Study to Evaluate the Efficacy and Safety of TEV-48125 (Fremanezumab) for the Prevention of Episodic Cluster Headache (ECH) |website=ClinicalTrials.gov}}</ref>
 
==References==
{{Reflist}}
 
==External links==
{{Medical resources
| DiseasesDB = 2850
| ICD10 = {{ICD10|G|44|0|g|40}}
| ICD9 = {{ICD9|339.00}},{{ICD9|339.01}},{{ICD9|339.02}},
| ICDO =
| OMIM =
| MedlinePlus = 000786
| eMedicineSubj = EMERG
| eMedicineTopic = 229
| eMedicine_mult = {{eMedicine2|article|1142459}}
| MeshID = D003027
}}
{{Diseases of the nervous system}}
{{Headache}}
 
{{DEFAULTSORT:Cluster Headache}}
[[Category:Ailments of unknown cause]]
[[Category:Headaches]]
[[Category:Neurological disorders]]
[[Category:Pain management]]
[[Category:RTT]]
[[Category:RTTEM]]