A 45-year old man presents with a daily headache. He describes two attacks per day over the past 3 weeks. Each attack lasts about an hour and awakens the patient from sleep. The patient has noted associated tearing and reddening of his right eye as well as nasal stuffiness. The pain is deep, excruciating, and limited to the right side of the head. The neurologic examination is nonfocal. The most likely diagnosis of this patient's headache is :

Answer is B (Cluster headache): Cluster Headache Lateralized , periorbital or less commonly temporal All ages above 10 yrs with peak at 30-50 yrs Male preponderance (90%). Men affected 7-8 times more than females. Hereditary factors usually absent Presentation: Pain (periodic attacks 1-2/day) begins without warning reaches crescendo within 5 minutes lasts for 45 minutes Q excruciating, deep, explosive pain but only rarely pulsatile - commonly awakens the patients from sleep Associated symptoms : These are typical and characteristic : - homolateral lacrimation - reddening of eye nasal stuffiness - Ptosis and - nausea Migraine Lateralised ,usually frontotemporal may be generalised All age groups are affected Females are affected more than males Family history present Presentation :Pain often preceded by aura builds up gradually - may lasts for several hours or longer - usually throbbing but may be dull - onset is after awakening & quietened by sleep Associated symptoms include : - nausea, vomiting, diarrhea photophobia and visual disturbance in the form of photopsia and foification spectra paraestheisias with tingling and numbness other focal neurological symptoms such as clumsiness and weakness.