6.4.1 Headache attributed to giant cell arteritis (GCA)

Identification: Male patient, 76 years old, Caucasian, retired, with a history of type 2 diabetes and osteoarthritis. Current Illness History: Reports persistent occipital headache for 4 weeks, with progressive worsening (intensity 8/10). Specific characteristics: Stabbing, continuous pain. Marked nocturnal exacerbation. Scalp tenderness when combing hair. Jaw claudication when speaking for prolonged periods. Systemic symptoms: Intermittent low-grade fever (max T° 37.9°C). Debilitating fatigue. Anorexia with a 6 kg weight loss over 6 weeks. Bilateral transient vision loss (2 episodes in the last week). Physical Examination: Vascular findings: Hardened and non-pulsatile temporal arteries. Bilateral carotid bruits. Ocular manifestations: Bilateral disc edema. Reactive but sluggish pupils. Functional limitation: Difficulty rising from a chair without support. Pain on shoulder abduction. Complementary Exams: Inflammatory markers: ESR: 112 mm/h (normal value <15). CRP: 76 mg/L (normal value <5). Serum IL-6: 48 pg/mL (elevated). Vascular imaging: PET-CT: intense uptake in thoracic aorta and main branches. Echo-Doppler: hypoechoic halo in temporal and occipital arteries. Temporal biopsy: Granulomatous panarteritis. Fibrinoid necrosis of the media. Multinucleated giant cells.