Thirteen patients who experienced severe cluster headaches and who met the criteria of sphenopalatine neuralgia underwent surgery for removal of the sphenopalatine ganglion. Seven patients obtained little relief, but six-month follow-up of one patient revealed that he was experiencing minimal pain. Four obtained sufficient relief so that analgesics were effective in controlling recurring headaches. Two have had complete relief for more than one year. Centrally located discharges within the brain stem may be responsible for the episodic pain. Regeneration of afferent nerve fibers may account for delayed recurrence of the pain following sphenopalatine ganglionectomy. Medical treatment is recommended in the majority of patients with this type of headache. Ganglionectomy should be reserved only for patients with intractable and severe headaches that do not respond to medical therapy.