Clusterlike headache as first manifestation of a prolactinoma

We report a case of cluster headache in a patient with a macroprolactinoma. Symptomatic cluster headache was suspected because of an unsatisfactory re sponse to medications that are usually effective in idiopathic cluster head ache. The neurological examination was normal. However, magnetic resonance imaging demonstrated a large pituitary tumor. One year after starting treat ment with cabergoline, the patient remains asymptomatic. Symptomatic cluste r headache should be suspected when the clinical features of the headache a re atypical. By inducing vascular mechanisms, the parasellar lesion may hav e played a role in initiating the cluster headache.