TY - JOUR T1 - Cluster headache in primary care: unmissable, underdiagnosed and undertreated JF - British Journal of General Practice JO - Br J Gen Pract SP - 486 LP - 487 VL - 56 IS - 528 AU - David Kernick AU - Manjit S Matharu AU - Peter J Goadsby Y1 - 2006/07/01 UR - http://bjgp.org/content/56/528/486.abstract N2 - Despite the substantial disability caused by headache disorders, they remain underdiagnosed and undertreated and in many cases the needs of the sufferer remain unmet. Cluster headache is one of the most painful conditions a GP will ever see and cluster sufferers may find themselves passing through ENT, ophthalmic or maxillo-facial departments with many years of intense suffering before a diagnosis is finally made.Cluster headache is a syndrome with a prevalence of approximately 0.1% characterised by a trigeminal distribution of pain, ipsilateral cranial autonomic features and a striking tendency to circadian and circannual periodicity. Unlike migraine where females predominate there is a male:female ratio 5:1.1 The most common age of onset is the third or fourth decade of life and available evidence suggests that it is a lifelong disorder in the majority of sufferers, but with longer remission periods over time.2 Although the exact pathogenesis remains unclear, the underlying abnormality is in the posterior hypothalamus with subsequent trigeminovascular and cranial autonomic activation.3 Alcohol, nitroglycerine, exercise, and elevated environmental temperature are recognised precipitants but allergies, food sensitivities, reproductive hormonal changes and stress do not appear to have any significant role.There are three significant features of cluster … ER -