Reference is made to a patient with an approximately 20-yr history of cluster headache and crises refractory to medical prophylaxis for 2 years prior to admission. Over the last 30 days, the picture had been complicated by resistance to ergotamine and motor deficiency in the right leg. Neuroradiological investigation revealed a lesion occupying the left parieto-occipital space. This remained undiagnosed. Its aetiology and clinical relations are discussed in the light of other cases of cluster headache associated with a demonstrated organic lesion described in the literature.
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