Ascending cluster headache: a description of three cases and a review of the literature

Introduction. It has been previously shown that cluster headache (CH) can involve some extratrigeminal areas. Occipital pain has been recognized in several patients, even as the origin of the attacks. Nevertheless, the proposals of topographic variations of CH have been mainly focused on the location of pain in either supraorbital or infraorbital regions. Case reports. We report three patients fulfilling International Classification of Headache Disorders criteria for CH whose attacks started with mild or moderate headache at the occipital region and gradually moved forward over 10 to 30 minutes, finally reaching the ipsilateral orbital area. There the pain acquired typical CH features, with severe intensity and ipsilateral autonomic accompaniments. Conclusions. These descriptions of ascending CH probably reflect pathophysiological mechanisms involving the trigeminocervical complex, and also offer theoretical support for some new therapeutic approaches such as great occipital nerve blockades or occipital neurostimulation.