Cluster headache, hemicrania, and other head pains: morbidity of carotid endarterectomy.

Carotid endarterectomy has become a widely used approach to the treatment of cerebrovascular disease. In spite of increasing experience, a significant and varied morbidity remains attached to the procedure. A poorly recognized complication is postoperative headache. In a series of 57 endarterectomies in 50 patients, 24 patients experienced postoperative headaches encompassing the entire spectrum of vascular headaches: nonspecific diffuse headaches, severe hemicranias, cluster headaches occurring early and delayed, chronic paroxysmal hemicranias, carotidynia, and Eagle's syndrome. Five patients had hemicranias, and all were homolateral to the endarterectomy. Therefore, we hypothesize that the spontaneously occurring hemicranias, the counterparts of postsurgical headache syndromes, also may be due to some overt or occult injury or disease of the carotid vessels or carotid sheaths in the regions from the carotid bifurcation to the base of the skull.