Cluster headache variant. Spectrum of a new headache syndrome.

The syndrome of cluster headache variant is characterized by the occurrence of three combined symptoms: atypical cluster headaches, multiple jabs, and background vascular headaches. Atypical cluster headaches are localized headaches that occur several times daily, usually without any headache-free periods. They differ from the typical chronic cluster headache in their location, duration, frequent shifting, and frequency. Multiple jabs are short-lasting, sharp pains of variable severity and location. Background vascular headache is a chronic, continuous often unilateral headache of variable severity that throbs at rest or begins to throb during exertion. We have studied 54 patients between the ages of 14 and 78 years (average age, 40.5 years). Forty-five (83%) patients responded to indomethacin. Complete control was achieved in 50% of the patients. The nine patients who did not respond to indomethacin were depressed. These nine patients responded well to tricyclic antidepressants.