Cluster Headache Presenting As Sinonasal Pathology in a Young Adult: A Diagnostic Odyssey

TL;DR

A young adult's cluster headache was initially mistaken for a nasal issue, highlighting the difficulty in diagnosing atypical headache cases.

Contribution

This case highlights the diagnostic challenges of atypical cluster headache presentations and underscores the importance of thorough clinical evaluation.

Findings

The patient's initial symptoms mimicked sinonasal pathology, leading to inappropriate investigations.

Persistent and evolving symptoms prompted a comprehensive assessment leading to a cluster headache diagnosis.

The case emphasizes the need for early recognition of cluster headaches for effective treatment.

Abstract

Cluster headache is a debilitating primary headache disorder marked by severe, unilateral pain often accompanied by autonomic symptoms. We describe the case of a 20-year-old student who presented with excruciating peri-orbital pain localized to the right side, accompanied by ipsilateral nasal obstruction, a nasal spur, and a deviated nasal septum (DNS). The initial clinical picture strongly suggested sinonasal pathology, leading to investigations and treatments aimed at this presumed diagnosis. However, as the patient's symptoms persisted and evolved over time, with episodes of recurrent and intense pain associated with ipsilateral tearing, rhinorrhea, and ptosis, further evaluation was pursued. A comprehensive assessment, including detailed headache characteristics, neurological examination, and neuroimaging, ultimately revealed the diagnosis of cluster headache. This case emphasizes the diagnostic challenges associated with atypical presentations of cluster headaches, the importance of a meticulous clinical evaluation, and the need for early recognition to provide timely and effective interventions for these severely affected individuals.

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