Open Access

Non–hypothalamic cluster headache: the role of the greater occipital nerve in cluster headache pathogenesis

The Journal of Headache and Pain20056:171

https://doi.org/10.1007/s10194-005-0171-4

Received: 17 December 2004

Accepted: 3 March 2005

Published: 13 May 2005

Abstract

Cluster headache is marked by its circadian rhythmicity and the hypothalamus appears to have a significant influence over cluster pathogenesis. However, as not all cluster patients present in the same manner and not all respond to the same combination of medications, there is likely a nonhypothalamic form of cluster headache. A patient is presented who began to develop cluster headaches after receiving bilateral greater occipital nerve (GON) blockade. His headaches fit the IHS criteria for cluster headache but had some irregularities including frequent side shifting of pain, irregular duration and time of onset and the ability of the patient to sit completely still during a headache without any sense of agitation. This article will suggest that some forms of cluster headache are not primarily hypothalamic influenced and that the GON may play a significant role in cluster pathogenesis in some individuals.

Key words

Cluster headacheHypothalamusGreater occipital nerveNerve blockade