Valsalva-induced cluster: a new subtype of cluster headache

We report the case of a man who suffered from Valsalva-induced cluster headaches. The headaches deviated from classic cluster in that they were solely induced by activity involving the Valsalva maneuver, such as coughing and sneezing, and never occurred spontaneously. The attacks were prevented by treatment with indomethacin. This may be the first reported case of cluster that only occurs after a defined trigger and never spontaneously. It also may be the first cluster headache subtype that is indomethacin responsive.