Cluster headaches are characterized by strictly unilateral paroxysmal attacks of 
severe pain with associated autonomic sign and symptom. Prevalence is 5 times 
higher in men than in women in our cases. About 10-15% of patients have chronic 
symptoms without remissions, but we estimated less frequent in Japanese (6.6% in 
our series). Pain almost invariably recurs on the same side, but in some 
patients (16.4%) the affected site switches. Cluster headache may be inherited 
in about 5% of our cases. Attacks frequently occur at night (60.7%). The 
patients (64.8%) are restless or agitated during an attack. Recent PET studies 
elucidated that acute attacks causes activation of the posterior hypothalamic 
grey matter. The excitement of the area might be responsible for peculiar 
clinical characteristics of agitation. Some patients (66.0%) have also have 
symptoms (especially a visual aura) usually attributed to migraine. Treatment of 
cluster headache includes both acute therapy aimed at aborting individual 
attacks and prophylactic therapy aimed at preventing recurrent attacks during 
the cluster period. There are many choices using for both therapies. Based on 
our clinical experience, we recommended the combination of nasal sumatriptan for 
acute attacks and verapamil 240 mg/day for prophylaxis.