Cocaine acts as a potent sympathomimetic and local anesthetic by blocking the reuptake of dopamine, norepinephrine, and serotonin at synaptic terminals, leading to enhanced neurotransmitter concentration. In cluster headache treatment, intranasal cocaine rapidly induces vasoconstriction and provides rapid pain relief through its sympathetic nervous system modulation and central nervous system effects. Its use is strictly controlled due to high addiction potential and significant systemic toxicity.