Aches and Tears

A 22 year old man presents with a recurrent, severe headache in the left periorbital region for 5 months, which occurred between 5 to 10 times each day.

The episodes were abrupt in onset, lasted between 30 minutes to 2 hours, and were accompanied by lacrimation and rhinorrhea.

There was no aura or any obvious precipitating factors. His medical and surgical histories are unremarkable.

He had self-medicated himself with acetaminophen (paracetamol) and ibuprofen so far.

Select Relevant Investigations
MRI + MRA brain

Performed

No structural or vascular lesions are detected.
Temporal artery biopsy

Performed

You realize that a temporal artery biopsy is probably not indicated here.
PET Scan : Brain

Performed

A PET scan will be arranged tomorrow.
Lumbar Puncture

Performed

The CSF fluid analysis is completely normal.

Select Relevant Management
100% Oxygen
Sumatriptan
Calcium Channel Blockers
Diclofenac