3.1 Cluster headache

A 53-year-old pharmacist reports eight attacks of headache over the past five days, each one an episode of very severe, excruciating pain that she rates as the worst pain of her life. The pain is felt deep in and around the right eye and stays strictly on the right side. During an attack she cannot lie down, walking up and down and describing a marked restlessness and agitation that she finds almost as distressing as the pain itself. Without treatment an attack runs for about 70 to 75 minutes and then fades over a few minutes. She is currently getting about four attacks per day, two of them typically at night. She denies any loss of vision, floaters, flashes, halos, eye discharge, nausea or vomiting.