pearljam59
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A 32-year-old man comes to the physician because of a 3-year history of knife-like headaches centered on his left eye. They awaken him at night and are associated with left eye lacrimation and rhinorrhea. Over a 2-month period, they occur nightly, last 30 minutes, and resolve. They typically do not occur again for another year. Which of the following is the most likely diagnosis?
A. Cluster headache
B. Intracranial mass
C. Migraine
D. Tension-type headache
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| vanshita
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B?
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| vanshita
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sorry its A
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| pearljam59
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Why?
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| doc179
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: Cluster headache, also known as histamine headache, is a form of neurovascular headache. Attacks usually are severe and unilateral and typically are located at the temple and periorbital region. The pain is typically associated with ipsilateral lacrimation, nasal congestion, conjunctival injection, miosis, ptosis, and lid edema. Each headache is brief in duration, typically lasting a few moments to 2 hours. Cluster refers to a grouping of headaches, usually over a period of several weeks.
The 2 existing forms of cluster headache are (1) episodic clusters with attack phases lasting 4-16 weeks followed by a cluster-free interval of 6 months to years, and (2) chronic form, in which the cluster-free interval is less than 1 week in a 12-month period.
Pathophysiology: The pathophysiology of cluster headaches is not well understood. Some proposed mechanisms are described here.
Hemodynamic: Vascular dilatation may play a role, but blood flow studies are inconsistent. Extracranial blood flow (hyperthermia and increased temporal artery blood flow) increases but following the onset of pain. Vascular change is considered secondary to primary neuronal discharge.
Trigeminal nerve: The trigeminal nerve may be responsible for neuronal discharge causing cluster headaches. Substance P neurons carry sensory and motor impulses in the maxillary and ophthalmic divisions of the nerve. These connect with the sphenopalatine ganglion and interior carotid perivascular sympathetic plexus. Somatostatin inhibits substance P and reduces the duration and intensity of cluster headaches.
Autonomic nervous system: Sympathetic (eg, Horner syndrome, forehead sweating) and parasympathetic (eg, lacrimation, rhinorrhea, nasal congestion) effects occur.
Circadian rhythm: Cluster headaches often recur at the same time every day, suggesting that the hypothalamus, which controls circadian rhythms, may be the site of activation.
Serotonin: This is not as striking as in migraines but some changes are seen.
Histamine: Although evidence supporting a causative role is inconsistent, cluster headaches may be precipitated with small amounts of histamine. Antihistamines do not abort cluster headaches.
Mast cells: Increased numbers of mast cells have been found in the skin of painful areas of some patients, but this finding is inconsistent.
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| druas
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A...
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| hellohie
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ITS A.
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| yasmeen
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its a for sure
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| DrVirgo
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I agree with A as well.
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| waqastariq
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doc179 has given a very wonderful explanation...
typical headache free interval is found in cluster headaches with typical manifestations told in the question...
thanks 
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| robin082006
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excellent post doc179, thanks
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