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Cluster Headache

Aches and Tears

Step 1: View clinicals

A 22 year old man presents with a recurrent, severe headache in the left periorbital region for 5 months, which occurred between 5 to 10 times each day. The episodes were abrupt in onset, lasted between 30 minutes to 2 hours, and were accompanied by lacrimation and rhinorrhea. There was no aura or any obvious precipitating factors. His medical and surgical histories are unremarkable. He had self-medicated himself with acetaminophen (paracetamol) and ibuprofen so far.

Step 2: Order all relevant investigations

MRI + MRA brain

No structural or vascular lesions are detected.

Temporal artery biopsy

You realize that a temporal artery biopsy is probably not indicated here.

PET Scan : Brain

A PET scan will be arranged tomorrow.

Lumbar Puncture

The CSF fluid analysis is completely normal.

Step 3: Select appropriate management

100% Oxygen
Calcium Channel Blockers

Score: ★★☆