3.1.2 Chronic cluster headache

Identification: Male patient, 45 years old, Caucasian, plumber.

History of Present Illness: The patient reports a history of intense, unilateral, periorbital and temporal headache, lasting 30 to 90 minutes, occurring on average 3 to 4 times a day for approximately 2 years. The attacks are accompanied by tearing, nasal congestion, eyelid ptosis, and psychomotor agitation. He states that the pain is so intense that it causes him to walk or rock his body during the attacks. There is no report of aura or prodromal symptoms. The patient mentions that the episodes occur in clustering periods (bouts), with short or absent remission intervals (less than 1 month), characterizing the chronic form of the disease.

Past Medical History: Well-controlled arterial hypertension with medication. Denies history of migraine or other primary headaches.

Physical Examination:

General: Patient conscious, oriented, emaciated (reports loss of appetite due to the attacks).

Neurological: Mild left eyelid ptosis during the attack, without other focal deficits.

Ophthalmological: Pupils are isocoric, photoreactive, without fundoscopic changes.

ENT: Nasal mucosa hyperemic on the left during the attack.

Complementary Exams:

Cranial magnetic resonance imaging: Normal, without structural lesions.

Magnetic resonance angiography: No significant vascular changes.