A 31-year-old man presents to his GP with a two week history of headaches around the left side of his face associated with watery eyes. He describes having about two episodes a day each lasting around 30 minutes. What is the likely diagnosis?
A. Migraine
B. Cluster headache
C. Trigeminal neuralgia
D. Acute angle closure glaucoma
E. Meningioma
Answer:
B. Cluster headache
Discussion: Episodic eye pain, lacrimation, nasal stuffiness occurring daily - cluster headache.
Cluster headaches are more common in men (5:1) and smokers.
Clinical Features
- pain typical occurs once or twice a day, each episode lasting 15 mins - 2 hours
- clusters typically last 4-12 weeks
- intense pain around one eye (recurrent attacks 'always' affect same side)
- patient is restless during an attack
- accompanied by redness, lacrimation, lid swelling
- nasal stuffiness
- miosis and ptosis in a minority
Management
acute: 100% oxygen, subcutaneous or a nasal triptan
prophylaxis: verapamil, prednisolone
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