A 17-year-old boy presents to your clinic with a 6-month history of recurrent headaches.

The classic description of brief, severe unilateral periorbital pain with autonomic symptoms (tearing), occurring in clusters (same time daily for weeks), is diagnostic of cluster headache.

Toronto Notes 2023 – Neurology, “Headaches”:

“Cluster headaches: severe unilateral periorbital pain, often with lacrimation, nasal congestion, occurring in clusters over weeks. More common in young males.”

MCCQE1 Objectives (Internal Medicine > 35-2: Headache Disorders):

“Candidates must distinguish among headache types based on duration, pattern, and associated symptoms.”

Migraine tends to last hours and has nausea or photophobia. Sinusitis causes dull, pressure-like pain. Tumour-related headache is progressive and worse with Valsalva. Post-concussive headache would have trauma history.

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