Q: Every afternoon like clockwork, I experience a burning sensation that begins at the right side of my forehead and crosses to the left side. It surrounds my eyebrows and eyelids. It’s not too dissimilar to the sensation of sunburn, but the best way to describe it would be tightness in the forehead. It can cause my eyelids to burn and swell, and exacerbate my dry-eye problem. At times, I experience a sharp dagger like pain in my right eye and under the brow bone. The whole thing lasts about three hours. A CT scan of my sinuses was clear. Is this description consistent with cluster headaches?
A: Cluster headaches usually present with one-sided tearing, drooping eyelid and redness in the affected eye. The typical cluster headache lasts 15 minutes to two hours and does not cross from one eye to the other. Due to the severe pain, patients prefer to stand up and walk, or rock back and forth. This contrasts with migraine, in which patients prefer to lie down in a dark, quiet room.
Although people with cluster headache do not always manifest typical textbook symptoms, there is a possibility you may have a migraine variant and not a cluster headache. If a neurological workup and CT or MRI scans of the brain are negative, it may be worth considering migraine-specific medications, such as topiramate, divalproex sodium or beta blockers. If you can tolerate nonsteroidal anti-inflammatories, you may want to try a trial of indomethacin as well.
George R. Nissan, DO, co-director, Diamond Headache Clinic, Chicago