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Cluster headache after herpes zoster ophthalmicus.

To the Editor.— The article by Appenzeller et al (Archives1981;38:302-306), which suggested that cluster headache may be due to "an axonal reflex in the trigeminal system, initiated perhaps by latent viral infection or IgE activation of mast cells," raised some important clinical points. Recently we studied a 52-year-old man with chronic cluster headache. Report of a Case.— A 49-year-old man had a left herpes zoster ophthalmicus. Three months later, he had the first attack of pain deep in and around the left eye and on the temple, with lacrimation from the eye and blocked nostril, which lasted two hours. At the time of admission, the attacks had recurred on the same side each day for three years, usually between 9 and 11pm. Results of general and neurologic examinations (including EEG, roentgenograms of the skull, computed tomographic scan, laboratory investigations) were normal. Treatment with steroids dramatically lessened the cluster