Vignette says a 35 year old male presents to the neurology clinic with severe, episodic, unilateral periorbital pain, that started 48 hours ago; The pain is excruciating, stabbing in nature and lasts around 30-90 minutes; He also reports of having ipsilateral eye reddening with lacrimation, nasal stuffiness/rhinorrhea, ptosis and miosis during these attacks; He has had multiple episodes daily, often occurring at night, waking him from sleep; He reports of having similar headaches in the past, occuring in cycles that last for weeks to months (cluster periods), followed by months of remission; MRI of brain is normal; Diagnosis?
Diagnosis is Cluster headache.
Clinical Features:-
1. Severe episodic unilateral periorbital (intense/sharp) pain; attacks lasting 15 minutes to 3 hours with spontaneous remission; worsened by alcohol and during night; men being 10 times affected as compared to women.
2. P/E shows autonomic symptoms (e.g. ipsilateral horner syndrome; nasal stuffiness/rhinorrhea; eye reddening with lacrimation).
1. Severe episodic unilateral periorbital (intense/sharp) pain; attacks lasting 15 minutes to 3 hours with spontaneous remission; worsened by alcohol and during night; men being 10 times affected as compared to women.
2. P/E shows autonomic symptoms (e.g. ipsilateral horner syndrome; nasal stuffiness/rhinorrhea; eye reddening with lacrimation).
Treatment:-
A. Abortive therapy:-
1. 100% of oxygen(1st line agents).
2. Triptans (e.g. intranasal sumatriptan 20 mg/ subcutaneous sumatriptan 20 mg) or Ergotamines.
B. Preventive therapy(Prophylaxis):- Verapamil (1st line therapy); Corticosteroids, Sodium valproate, Lithium (2nd line therapy).
A. Abortive therapy:-
1. 100% of oxygen(1st line agents).
2. Triptans (e.g. intranasal sumatriptan 20 mg/ subcutaneous sumatriptan 20 mg) or Ergotamines.
B. Preventive therapy(Prophylaxis):- Verapamil (1st line therapy); Corticosteroids, Sodium valproate, Lithium (2nd line therapy).