Treat cluster headache as a time-sensitive syndrome: secure rapid abortive therapy, start preventive treatment early, and use the pathophysiology only insofar as it changes what you do at the bedside.

Cluster headache likely involves trigeminovascular, parasympathetic, and hypothalamic networks; Hypothalamic activation helps explain the circadian pattern of attacks; A cluster attack combines severe unilateral pain with ipsilateral autonomic symptoms; Subcutaneous sumatriptan is the fastest highly effective acute therapy; High-flow oxygen is a first-line abortive treatment with strong evidence