Cluster headache after orbital exenteration

A 56-year-old woman developed episodes of throbbing pain in the right orbit accompanied by ipsilateral nasal stuffiness and the feeling of ear swelling six months after orbital exenteration and ethmoidectomy for invasive, sclerosing basal-cell carcinoma. Extensive evaluation and treatment of her sinusitis failed to provide relief for her disabling symptoms. When treated by a neurologist with propranolol for cluster headaches, her symptoms subsided. To the best of our knowledge, this is the second patient with cluster headaches after orbital exenteration. Though no known causal relationship exists, these two patients document that orbital or ocular pain with cluster headaches is a referred or "phantom" pain and confirm the etiology of cluster headaches to lie outside the orbit.