3.1 Cluster headache

Identification: A 35-year-old male patient, engineer, smoker (1 pack/day for 15 years), social drinker, with no other known comorbidities. History of Present Illness: The patient reports recurrent episodes of severe, unilateral, periorbital and temporal headache lasting 30 to 90 minutes for approximately 3 months. The pain is described as "stabbing" or "piercing," associated with tearing, nasal congestion, and ipsilateral eyelid ptosis. The episodes occur predominantly at night, waking the patient from sleep, with a frequency of 1 to 2 times per day. He states that the pain is so intense that it prevents him from performing routine activities during the attacks. He also reports psychomotor agitation during the episodes, with a need to move constantly. There is no history of head trauma, fever, visual changes, or focal neurological symptoms. Family History: Negative for primary headaches. Physical Examination: General: Patient is conscious, oriented, in good general condition. Neurological: Pupils are isocoric, photoreactive, with no motor or sensory deficits. Mild right eyelid ptosis during the attack. ENT: Nasal mucosa hyperemic, without purulent discharge. Other systems: No relevant changes. Complementary Exams: Cranial MRI: Normal. MR angiography of intracranial arteries: No abnormalities. Complete blood count, biochemistry, and thyroid function: Within normal limits.