A 32-year-old man, about one month each year, wakes at night. Pain around the left eye lasts 30 to 60 minutes, with tearing and a blocked nose on the same side. He paces the room and cannot lie down. Between bouts he is free of symptoms for months.
He has had several courses of antibiotics for sinusitis, and nasal surgery has been suggested once.
Which pattern does this history fit?
The bouts, the length of attacks, the restlessness, and same-sided autonomic signs make cluster headache far more likely than sinusitis. Bacterial sinusitis does not keep a circadian rhythm with months of freedom.
Before a primary diagnosis is settled, a unilateral headache with autonomic signs should have been considered for a structural cause. Acute and preventive treatment is specific, and doses are not written here.
This is a teaching vignette and refers to no identifiable patient. These pages are written for health professionals. They do not replace a history, examination, or clinical judgment. Treatment is decided for each patient individually.