II. Classification
- Short duration
- Trigeminal Autonomic Cephalgia
- Headaches similar to Cluster Headache
- Unilateral trigeminal distribution symptoms with autonomic features
III. Symptoms
- Severity
- Severe pain
- Characteristics
- Unilateral orbital, supraorbital or temporal Headache
- Timing
- Duration of 2-30 minutes
- Recurs more than 5 times daily on >50% of days
- Palliative
- Relieved with Indomethacin (unlike Cluster Headaches which are not relieved with Indomethacin)
- Associated Symptoms (at least one of the following autonomic symptoms characteristic of Cluster Headaches)
- Lacrimation
- Ipsilateral forehead or facial Flushing or sweating
- Ipsilateral Nasal Discharge
- Affected eye red with dilated Conjunctival vessels (Conjunctival injection)
- Restlessness, pacing or rocking head in hands
- Horner's Syndrome (30% of cases)
IV. Diagnosis
- Characteristics: At least 20 or more Headaches meeting the following criteria
- Severe to very severe unilateral orbital, supraorbital or temporal pain lasting 2-30 minutes
- Headaches >5 times daily
- Prevented by therapeutic Indomethacin doses 150 to 225 mg in divided dosing per day
- Headache with at least one of the following ipsilateral autonomic symptoms
- Conjunctival injection or Lacrimation
- Nasal congestion or Rhinorrhea
- Eyelid Edema
- Forehead and facial sweating
- Miosis or Ptosis
- Restlessness or Agitation
- Timing
- Episodic
- Two or more cluster periods lasting 7-365 days and separated by pain-free remissions >3 month
- Chronic
- Episodes recur for more than 1 year without remission or with remission <3 month
- Episodic
- References
V. Differential Diagnosis
- See Cluster Headache