It is a chronic condition, which will recur over many years and the combination of adaptation, and preventive medications should be tailored for each patient. True migraine is disqualifying for flight and several other special duties in the military, primarily because of the risk for visual disturbance. According to the Manual of the Medical Department, severe or disabling migraine is disqualifying for naval service. If a patient fits into any of these categories, the GMO should consider referral to a medical board or operational specialty such as diving medical officer or flight surgeon. It occurs more often in men than women, and causes a stereotypical, excruciating pain behind the eye.
Attacks are always exactly alike, even if separated by many years.
The conjunctiva on the affected side is red, the eye tears copiously, and there may be ptosis and slight meiosis in the pupil. The attacks come several nights every week during the course of a cluster that can last for 2 to 6 weeks, seldom longer. The clusters disappear and may not recur for many years, but when they do, the patient recognizes them instantly. Initial therapy should include 100 percent oxygen by face mask initially since this provides good relief in many patients. Because of the short-lived nature of episodic cluster headaches, narcotics are not indicated for management.