Abstract

Cluster headache (CH) is a severe primary headache syndrome associated with autonomic syndrome. Treatment of CH involves acute attack management such as oxygen, sumatriptan and preventive therapy with verapamil, oral steroid and ergotamine. For refractory to those treatment, botulinum toxins type A (BTX-A) has recently been studied as a new preventive treatment for patient with refractory CH, with limited success. A 33-year-old man presented with a 2.5-year history of excruciating headache in right frontal and periorbital areas. He was getting an average of two to three attacks per day, each lasting between 30 mins and 2 hours. The attack was sometimes associated with conjunctival congestion and nasal stuffiness on symptomatic side. His headaches were previously managed with ergotamine, oral steroid, verapamil, lithium for 2 years. However, his headache recurred and getting worse during several months. BTX-A was injected into the temporalis, glabellar area, occipitalis and trapezius muscles bilaterally. Four weeks after injection, He experienced improvement of headache and oral steroid was tapered off. We report a case of intractable CH who was successfully treated with BTX-A.