Cluster-like hedache secondary to cavernous sinus metastasis

Cluster Headache (CH) is a primary disorder defined by the International Headache Society (IHS) classification (1) as severe, unilateral orbital, supra-orbital, or temporal pain lasting 15–180 min if untreated and associated to signs of dysfunction of the autonomic nervous system such as conjunctival injection, nasal congestion, lacrimation, Horner’s sign, and rhinorrhea. The attack frequency is ranged from one every other day to eight per day. In recent years several cases have been described concerning patients having cluster-like syndromes associated with intracranial pathologies, usually showing atypical manifestations with respect to the above mentioned diagnostic criteria (2). We report the case of a female patient affected by cluster-like headache completely fulfilling IHS diagnostic criteria, at least at presentation, who during the course of the illness presented clinical and neuro-imaging aspects of an organic brain lesion, e.g. a cavernous sinus metastasis.