AANP Family Nurse Practitioner (FNP) Certification ExamAssessmentMedium
A 55-year-old male presents with sudden onset of excruciating, unilateral retro-orbital pain, accompanied by ipsilateral lacrimation, conjunctival injection, nasal congestion, and ptosis. The attacks occur several times a day in clusters and last about 45 minutes. He denies aura or visual changes. Which of the following is the most likely diagnosis?
- ATension-type headache
- BCluster headache
- CTrigeminal neuralgia
- DMigraine with aura
Show answer & explanationAnswer & explanation
Correct answer: B. Cluster headache
The constellation of severe, unilateral retro-orbital pain, short duration (45 mins), multiple daily attacks in clusters, and prominent ipsilateral autonomic symptoms (lacrimation, conjunctival injection, nasal congestion, ptosis) is pathognomonic for cluster headache.
Why the other options are wrong
- A. Tension headaches are usually bilateral, dull, non-throbbing, and lack autonomic features.
- C. Trigeminal neuralgia causes sharp, lancinating pain in a specific trigeminal nerve distribution, often triggered by touch, and does not typically involve autonomic symptoms or last for 45 minutes.
- D. Migraine typically lasts longer (hours to days), often has aura, and autonomic symptoms are less pronounced and bilateral.
Cluster Headache
A severe primary headache disorder characterized by recurrent, short-lived (15-180 minutes), unilateral headaches occurring in clusters, accompanied by prominent ipsilateral autonomic symptoms.
- Excruciating, unilateral retro-orbital pain.
- Ipsilateral autonomic symptoms: lacrimation, conjunctival injection, ptosis, nasal congestion.
- Occurs in clusters, several attacks per day.
Memory trick: Headache Types: Migraine, Tension, Cluster - Know the Clues!