3.3 Short-lasting unilateral neuralgiform headache attacks

A 34-year-old florist reports recurrent pain around her left eye. She describes clusters of jabbing pain, moderate in strength, felt in and around the eye socket itself rather than the brow or temple, always confined to the left side. The pain comes as a rapid run of several stabs rather than one, each burst settling within about three and a half minutes. She now notices her left nostril blocking up during almost every attack, which clears again once the pain has passed. By her count she has had at least twenty-three episodes to date, occurring on average four times across a typical day. She reports no change in vision and no eye pressure symptoms.