3.1 Cluster headache

A 46-year-old hairdresser reports a headache that started twelve days ago and occurs in discrete attacks; she has recorded nine attacks in her diary. The pain is very severe and excruciating, which she likens to a red-hot poker, and is felt in and around the left eye, exclusively on the left side of the head. During every attack she becomes restless and agitated, pacing the room, unable to sit still, and on one occasion she went out into the street at night to walk it off. When untreated, an attack lasts about two hours, roughly 120 minutes. Her diary shows four to five attacks a day, an average of 4.5 per day, with a fairly consistent 1 a.m. attack. She denies nausea, vomiting, photophobia, visual aura and any sensory or motor symptoms.