Posted at 19:39h
in Ask the Expert
Lynda is a 44-year-old dental assistant who came to The New England Center for Headache in Stamford, Connecticut, with a one-week history of drooping of the right eyelid, a right-sided headache, and a diagnosis of cluster headache made by her family doctor. Her headache was intense and continuous, and her eyelid drooped more and more over the course of the week.
During my examination, Lynda told me she'd had a right-sided headache six months previously that was so severe she went to an emergency room for the first time in her life. All tests, including a spinal tap, CT, MRI and MRA (magnetic resonance angiogram, used to visualize the heart, blood vessels or blood flow in the circulatory system) were normal and the headache disappeared in about a week. At that time, she did not have a drooping eyelid.
The week before I saw her, however, she experienced the rapid onset of a right-sided, steady, intense pain which did not change. She gradually noticed that her eyelid was drooping. Everything was normal during my exam, except that her right eye was shut. When I lifted her eyelid and asked her to follow my light, the eye could only look to the right.
This finding concerned me. I did not think she had cluster headache, though that condition can be associated with a drooping eyelid, red and tearing eye, or stuffed or running nostril all on the same side as the pain. While these “clusters” of attacks are also quite severe, they last for only a short time (about 45-60 minutes) and reoccur a number of times per day, often at the same time every day, sometimes wakening the patient in the night. Lynda's headache was constant.