Restlessness occurs during cluster headache attacks and in response to painful stimuli that feel like stemming from an escapable source. Animal experiments show that being repeatedly subjected to restlessness-causing painful stimuli may result in learned helplessness, characterized by passivity and fear in response to pain, and potentially depression. This article reports a patient suffering from chronic cluster headache, whose ictal behaviour had transitioned from restlessness to quiescence and who felt intense fear at the beginning of each attack. We argue that this change may be due to learned helplessness and discuss implications. Learned helplessness might contribute towards a comorbid depression. It should be suspected when the ictal behaviour transitions from restlessness to quiescence, and patients report ictal fear.
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