3.1.2 Chronic cluster headache

A 42-year-old bus driver reports daily bouts of one-sided head pain that have carried on without a real break for the past twelve months; on the rare days the pain eased off, it never stayed away longer than a few weeks. He counts up to seven such bouts on his worst days, each one lasting roughly an hour and a half, sometimes nearer to an hour and forty minutes, before it settles. The pain sits above his right eye, is one-sided every time, and climbs to a severe intensity within minutes. During the bouts his nose feels blocked on the same side. Across the past year he has lost count of how many episodes he has been through, guessing it must run well into the thousands by now.