Cluster headaches, which arguably cause the worst pain of any headache, are not likely to be cured by trigger point injections, according to a group of Spanish doctors. They treated 12 patients with trigger point injections and some of the patients reported some relief, but they all needed medications as well. This is a small study without placebo control, which means that no conclusions can be made about usefulness of this treatment. We do have better evidence that occipital nerve blocks can be helpful in aborting cluster headaches. This is a procedure similar to trigger point injections, but it involves injection not only of a local anesthetic, but also a long-acting steroid into an area of the occipital nerve on the side of the headaches. It is a simple and safe procedure and it should be tried in most patients, particularly those who in addition to pain around the eye have pain or tenderness in the back of the head or upper neck.