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Objective: We present a rare case of Tic-cluster in the context of venous compression of the trigeminal nerve. Background: Cluster-Tic syndrome is a rare headache condition with features of both trigeminal neuralgia (Tic) and trigeminal autonomic cephalalgia symptom (TAC). Methods: Case report and review of literature. Results: A 75-year old man presents with left sided paroxysmal pain consistent with trigeminal neuralgia (Tic). Magnetic resonance demonstrated a venous compression of the posterior-medial aspect of the left trigeminal ganglion. He underwent microvascular decompression which confirmed petrosal vein compression with subsequent symptomatic resolution. After two years of remission, he had a new left unilateral throbbing headache consistent with International Classification of Headache Disorders (ICHD)3 cluster headache definition, which improved with steroids. Conclusion: Cluster-Tic syndrome has variable clinical presentations. Tic can precede cluster and the possible role of venous trigeminal compression in this headache remains unclear. www.ahmjournal.com Open Access Journal This is an open access journal distributed under the terms of the Creative Commons Attribution 4.0 License in which authors agree to make articles, including data, graphics, and supplements, legally available for reuse, without permission or fees, for virtually any purpose. Any individual or institution is free to copy, distribute, reproduce, or reuse these publications, as long as the author and original source are properly cited and credited. Introduction “Cluster-Tic” syndrome is a term used to describe the rare spectrum overlap of pain attacks resembling trigeminal neuralgia (Tic) and cluster or other trigeminal autonomic cephalalgia type pain (TAC)1 2. These can precede one another or coexist. We present an unusual case of Tic-cluster syndrome with Tic symptoms that went into complete remission following trigeminal nerve decompression then independent occurrence of new cluster symptomatology.

Cluster-Tic or Tic-Cluster? Trigeminal Neuralgia (Tic) Turning to Trigeminal Autonomic Cephalalgia (TAC) Following Venous Decompression of the Trigeminal Nerve: A Case Report and Review of the Literature