What is cluster tic syndrome?
The cluster tic syndrome features the primary symptoms of cluster headache but with the added component of stabbing, ice-pick neuralgic-like components involving the eye, face, and jaw. The syndrome is found in 10-20% of patients but is often undiagnosed. True trigeminal neuralgia may coexist with cluster headache.
Alberca and Ochoa (1994) reviewed 37 reported cases of cluster tic syndrome. They noted equal gender representation and found that trigeminal neuralgia usually appeared first. Some attacks appeared to blend both neuralgia and cluster headache symptomatology and could be triggered by touching of the upper lip on the involved side. Medical treatment was often not effective, although a combination of cluster headache therapy with that for trigeminal neuralgia was sometimes useful.
Several antineuralgic agents are available. These include carbamazepine, phenytoin, baclofen valproate, and clonazepam. Most recently, gabapentin has shown promising results in neuropathic pain disorders. As for surgical interventions, suboccipital surgery (Solomon, 1985) revealed compression of the trigeminal nerve by aberrant vasculature, and following treatment, the neuralgic component resolved.