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JAMA Neurology Clinical Challenge
June 2016

Keeping an Eye on This Headache

Author Affiliations
  • 1Department of Neurology, Inselspital, University Hospital Berne and University of Berne, Switzerland
  • 2Department of Neurology, Schlosspark-Klinik, Berlin, Germany
JAMA Neurol. 2016;73(6):751-752. doi:10.1001/jamaneurol.2016.0346

A 24-year-old woman was referred to our clinic for evaluation and treatment of a first-ever episode of headaches that occurred 16 days before the consultation. She reported a strong unilateral headache located in her left cheek, eye, and forehead that evolved during the evening hours, peaked at night, and decreased again until the morning, without any remarkable trigger. This first episode went along with ipsilateral lacrimation, a red eye, and periorbital swelling but without ptosis, which she documented with her smartphone (Figure 1). During a painful night, she could not sleep. Pain remitted, but the swelling increased until the next morning and slowly decreased over approximately 36 hours. Recurrent but less intense episodes of several hours’ duration occurred during the 2 subsequent nights with no symptoms during the following 14 days. The patient reported no nasal congestion, nausea, vomiting, or phonophobia or photophobia. The patient reported being an infrequent smoker, with about 2 cigarettes a month.

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