Cluster like headache in an elderly patient with lateral medullary infarct: does the clue lie somewhere else?

Cluster headache is a relatively uncommon primary headache. The exact aetiology of cluster headache is yet unknown. There are rare case reports of cluster like headache in patients who have had vascular insults, either in the form of a dissection or an ischaemic infarct. The case of a 73 year old man is presented, who had a transient ischaemic stroke with dizziness, vomiting, left leg weakness and non-specific occipital headache that resolved in one day. Two days later, he developed features of partial Wallenberg syndrome which was confirmed on magnetic resonance imaging. One day after the onset of Wallenberg syndrome, he developed typical features of cluster like headache ipsilateral to the stroke, site. The headache was treated with traditional therapy of cluster headache including high flow oxygen and verapamil. The patient responded well to the treatment. This case suggests a possible link of lateral medulla to cluster like headache etiology and further emphasizes that semiology of cluster headache can be secondary to central lesions.