ABSTRACT

Clinicians such as John Graham painted a physical and emotional picture of cluster headaches that is dubious in its relation to the headache disorder itself. Some describe patients with cluster headaches as having distinguishing facial characteristics such as peau d’orange skin, deep vertical facial creases, a ruddy complexion, and frequent facial telangiectasia. The use of alcoholic beverages may serve a trigger for cluster headaches when a patient is in cycle. It is rare to find a patient with cluster headache who will not have an acute attack of headache that is precipitated within minutes of ingestion of even minimal amounts of alcohol. The term, cluster headache, seems appropriate since the attacks occur in a group of headaches with a frequency from once to multiple times per day over a period of several weeks to many months; a pain-free period occurs spontaneously only to have the cluster headache recur at a later time.