Recurrence of cluster headache after carotid thrombendarterectomy

The pathophysiology of cluster headache is largely unknown. One important contributing factor may be an abnormal intracranial-extracranial hemodynamic state. A male patient suffered from chronic left-sided cluster headache for about 15 years. After the institution of lithium therapy the symptoms abated. He was completely free from cluster headache for more than 20 years, until the first postoperative day after a thrombo-endarterectomy for symptomatic 70% carotid stenosis. This case report indicates the importance of abrupt carotid hemodynamic changes along with dysfunction of the cephalic sympathetic nervous system in the initiation of cluster headache.