Navigating the waves of cluster headache
Leiden Repository June 18, 2026 W.c. Naber
Cluster headache is characterized by recurring 'waves' of attacks. Long-term remission is linked to episodic disease, later onset age, more painful attacks, and smoking cessation, suggesting smoking may play a role in disease development. People with cluster headache more often use psilocybin and LSD, with some reporting reduced attack frequency or duration. Risk-taking behavior is increased in episodic but reduced in chronic disease, indicating adaptive changes. Testosterone deficiency is more prevalent, especially in chronic cases, likely originating in the brain. A Dutch version of the Cluster Headache Quality of Life questionnaire was developed; quality of life is more strongly tied to mental health and activity limitations than attack frequency alone. Greater occipital nerve infiltration is clinically effective, but its mechanism remains unresolved.