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Cluster-Tic Syndrome: A Cross-Sectional Study of Cluster Headache Patients


  • Conflicts of Interests: Michel D. Ferrari, MD, PhD, has, in the past 3 years, received grants and consultancy/industry support from Almirall, Coherex, Colucid, Eisai, GlaxoSmithKline, Linde, MAP, Medtronic, Menarini, Merck, Minster, Pfizer, and St. Jude, and independent support from the Netherlands Organisation for Scientific Research (NWO). Joost Haan, MD, PhD, received consultancy support from Merck. Leopoldine A. Wilbrink, MD, received consultancy/industry support from Medtronic, Menarini, Allergan, Neurocore and independent support from Fonds Nuts Ohra. Claudia M. Weller, MD, and Carlo Cheung, MD, report no disclosures.

Address all correspondence to L. A. Wilbrink, Department of Neurology, K5-Q, PO Box 9600, 2300 RC Leiden, The Netherlands, email:



To determine the prevalence and nature of trigeminal neuralgia in a large group of cluster headache patients.


Cluster-tic syndrome is a rare headache syndrome in which trigeminal neuralgia and cluster headache co-occur. The existence of cluster-tic syndrome as a separate entity is questioned, and figures on prevalence of simultaneous existence of cluster headache and trigeminal neuralgia are not available.


As part of a nationwide study on headache mechanisms in cluster headache (Leiden University Medical Centre Cluster headache Neuro Analysis programme), we collected clinical data of 244 cluster headache patients using a semistructured telephone interview in a cross-sectional design.


In 11 (4.5%) cluster headache patients, attacks fulfilling International Headache Society criteria for trigeminal neuralgia were also present. In all cases, trigeminal neuralgia occurred ipsilateral to cluster headache and in the majority (82%) in the ophthalmic branch. In 8 of these 11 patients (73%), the frequency and time pattern of trigeminal neuralgia seemed to parallel cluster headache and was likely a part of the cluster headache spectrum. In the 3 remaining patients, cluster headache and trigeminal neuralgia were unrelated in time and appeared to occur independently.


Trigeminal neuralgia co-occurred in 11/244 (4.5%) of cluster headache patients. In only 3 (1.2%) patients, trigeminal neuralgia seemed to occur independently from cluster headache episodes. Trigeminal neuralgia (-like) attacks in cluster headache patients are most of the time part of the cluster headache spectrum and should then probably not be treated separately. A shared underlying pathophysiological mechanism of cluster headache and trigeminal neuralgia is not supported by this study.