Objective: To describe the evolution of 15 patients who were treated for difficult-to-control episodic and chronic cluster headaches with clomiphene. Methods: Clomiphene treatment was used for seven chronic and eight episodic cluster headache patients. The chronic patients were refractory to the medication being used, and the episodic patients, in addition to being resistant to conventional medication, had longer cluster headache periods, exceeding the average time of previous cluster cycles. Our main analysis was of the time to pain-free, complete remission, and the length of pain-free time and complete remission. Results: Clomiphene was used for 45-180 days. The average time to being pain-free was 15 days and cluster remission was up to 60 days. The average time between being pain-free until cluster remission was 26 days. Conclusions: Clomiphene treatment was significantly efficient. It interrupted chronicity in all patients, suggesting the capability of changing the pattern of attacks. It proved to be safe and well tolerated. Keywords: headache; therapeutics; testosterone; clomiphene; hypothalamus RESUMO Objetivo: Descrever a evolução de 15 casos de cefaleia em salvas de difícil controle, episódicos e crônicos, tratados com clomifeno. Métodos: Foram tratados 7 casos crônicos e 8 episódicos. Os crônicos, refratários aos medicamentos preventivos em uso e os episódicos, além de refratários, apresentaram salva mais longa que as anteriores. Foram analisados o tempo para a ausência das crises, fim da salva e o tempo entre os dois parâmetros. Resultados: O clomifeno foi usado por 45 a 180 dias. A média de tempo para a remissão das crises foi de 15 dias e da salva foi de 60 dias. A média entre o fim das crises e da salva foi de 26 dias. Conclusão: O clomifeno foi eficaz em ambos os padrões. Foi capaz de interromper a cronicidade em todos os casos, o que sugere uma ação neuromodulatória capaz de mudar o padrão das crises. Mostrou-se seguro e bem tolerado.Palavras-chave: cefaleia; terapêutica; testosterona; clomifeno; hipotálamo Patients who were treated for difficult-to-control episodic and chronic cluster headaches and results are described. Hypothalamic modulation by means of hormone treatment seems to be the new solution for preventive treatment.Cluster headache is certainly the most painful and incapacitating of primary headaches, particularly for patients who suffer from long bouts or for those who present with the chronic form. Cluster headaches are characterized by a periorbital unilateral pain associated with ipsilateral autonomic signs (ptosis, miosis, conjunctival hyperemia, tearing, rhinorrhea, nasal congestion). Its episodic form is characterized by weeks or months (cluster periods) of pain, separated by painfree intervals of months or years 1 . Chronic cluster headaches affect nearly 10% of patients and episodes persist for at least one year with no remission or with remissions that last for at least one month. These patients usually need one or two preventive drugs such as corticosteroids, verapa...