Carotid paraganglioma mimicking a cluster headache

A 60-year-old woman presented a 3 day-history of severe recurrent right periorbital pain, with ipsilateral conjunctival injection and lacrimation, lasting 20 minutes, occurring five times a day. Those features satisfied criteria A to D of cluster headaches (CH) of the International Classification of Headache Disorders (1). Criterion E implies the exclusion of symptomatic etiologies, thus cerebral and cervical MRI imaging was performed, revealing a voluminous ipsilateral carotid paraganglioma (Figure 1). After a complete resection of the paraganglioma, CH was resolved. Several etiologies of secondary CH have already been described, mainly carotid dissections (2,3). Carotid paraganglioma should be added to the list.

Figure 1.

Axial cervical MRI, T1- (a), T2- (b) and contrast enhanced T1-weighted images (c) show a paraganglioma (arrows) with typical ‘salt and pepper’ aspect and enhancement after gadolinium injection, surrounding the right internal carotid artery (arrowheads). MR angiography (d) demonstrates a hypervascular tumor very close to the body of the right internal carotid artery (ICA) (black arrow).