Abstract
There have been remarkable strides in the last decade in unraveling the mystery of primary headache disorders, such as migraine and cluster headache. The vascular theory has been superseded by the neurovascular phenomena which seems to be the permissive triggering factor in migraine and cluster headache. This has been achieved through new imaging modalities, such as positron imaging tomography and functional magnetic resonance imaging. Prior to these imaging techniques, it was impossible to study primary headache disorders since they have no structural basis. There is now an increasing body of evidence for the brain to be involved primarily in cluster and migraine and the vessel dilatation as an epiphenomenon. There are also better strategies for treating cluster headache. Most of the targets for abortive treatment remain vascular, however, for prevention neuromodulators, such as antiepileptics may be used in addition to calcium channel blockers. This review will discuss the treatment strategies based upon the pathophysiological basis for this disorder.