Cluster Headache: Literature Review with Reference to Sex Differences

Abstract

Cluster headache is a pain syndrome characterised by severe, unilateral and predominantly orbital pain which lasts 15 - 180 minutes. It is accompanied by a range of ipsilateral autonomic symptoms, such as lacrimation, rhinorrhoea and myosis. Cluster headaches can be episodic with periods of remission or chronic. Even though it is a relatively rare condition, the excruciating pain causes significant disruption of patients’ daily life. The pathophysiology behind cluster headaches is complex and despite making significant progress, the pathogenetic cascade of events hasn’t been entirely elucidated yet. However, research into this subject has discovered brain structures, peripheral pathways and neuropeptides which have key roles in pathogenesis. The basis of diagnosing cluster headaches is a detailed patient history and the exclusion of other primary headaches and potential secondary causes. Sex differences in clinical presentation need to be taken into consideration in order to avoid misdiagnosis. Treatment options are divided into three categories: acute, transitional and prophylactic treatment. Although there are a lot of treatment modalities available, further research is necessary in order to find new therapeutic targets and more effective prophylaxis, especially for chronic cluster headache.