Cluster headache is a well-known primary headache syndrome with a prevalence of 
about 5/10,000 of the adult population, making it much less common than 
migraine. Diagnostic terms such as histaminic cephalalgia, Horton's headache and 
ciliary neuralgia have been used for what is now known as cluster headache. This 
disorder can be differentiated from migraine by clinical and pathophysiologic 
features. Cluster headache also exhibits a differing therapeutic response to 
medications when compared with migraine. The pharmacologic treatment of cluster 
is reviewed in this article. In contrast to migraine, men are 3-4 times more 
likely to be diagnosed with cluster headache than women, and the cluster 
headache population is older. Cluster attacks are known for their brief intense 
unilateral excruciating pain during susceptible periods known as cluster 
periods, which typically last weeks. Attack-free months generally follow. Pain 
is experienced in the distribution of the trigeminal nerve, with unilateral 
autonomic features. Most patients are successfully managed with medical therapy. 
Medication management can be divided into abortive treatments for an ongoing 
attack and prophylactic treatment. Prophylaxis aims to induce and maintain a 
remission. There are a variety of different medications for abortive and 
prophylactic therapy, accompanied by a variable amount of evidence-based 
medicine. For patients refractory to medical management, interventional 
procedures are available as a last resort. Most procedures are directed against 
the sensory trigeminal nerve and associated ganglia, eg, anesthetizing the 
sphenopalatine ganglion.