The Practitioner
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Cluster headache is a strictly unilateral headache that occurs in association with cranial autonomic features. Although it can begin at any age, the most common age of onset is in the third or fourth decade of life. The diagnosis is purely clinical and it is therefore crucial to take a good history looking for its distinctive features. ⋯ The majority of patients will have episodic cluster headache with recurrent bouts separated by remission periods of more than a month. The remaining 10-20% have chronic cluster headache and no significant remission periods over the course of a year. Specialist advice should be sought at first presentation for confirmation of diagnosis, development of a plan for managing current and future cluster bouts and where first-line treatments fail.