Two cases of cluster headache effectively treated with levetiracetam.

Cluster headache (CH), which is characterized by recurrent attacks of short-lasting excruciating pain accompanied by signs of autonomic dysfunction (ICHD-II) (Headache Classification Subcommittee of the IHS, 2004), is the most severe of the primary headache syndromes. CH is the most common of the trigeminal autonomic cephalalgias (TACs), whose pathophysiology has not been completely elucidated ( Leone and Bussone, 2009). The treatment of CH is still debated. Verapamil (a calcium antagonist) and lithium are the first-option drugs. Several drugs have been proposed as alternative treatments, but only some of these showed limited efficacy. Recently, a new-generation antiepileptic drug, topiramate (200 mg/day), was reported to ameliorate CH ( Leone et al., 2003). Here we describe two cases of CH that became unresponsive to classical treatment and were effectively treated with levetiracetam (LEV).