A Case of Varicella-Zoster Virus Meningitis Presenting with Cluster Headache-Like Symptoms

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Key Points

This case describes a patient with varicella-zoster virus (VZV) meningitis presenting atypically with cluster headache symptoms.
Clinical presentation of headache, ocular pain, and conjunctival injection was followed by treatment with sumatriptan and oxygen therapy.
Cerebrospinal fluid analysis was performed on day three, detecting VZV-DNA.
Observation of subsequent rash in the trigeminal region on day seven.
Initial treatment for cluster headache was ineffective.
VZV-DNA was detected in the cerebrospinal fluid at a concentration of 2.1 × 10^4 copies/mL.
A rash appeared in the trigeminal area days after the headache onset, confirming the diagnosis.

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A case report identifies varicella-zoster virus meningitis with unusual headache symptoms, suggesting early CSF analysis is crucial.

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Matsui et al. (2026) studied this question.

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