Severe aching pain, intensified by chewing; tenderness over temporomandibular joints; malocclusion, missing molars
Intense sharp, aching pain, associated with ophthalmoplegias and sensory loss over forehead; pupil usually spared
Intense sharp or aching pain, ptosis, miosis, preserved sweating
Both sexes, constant dull ache 2-4 h
Chewing, pressure over temporomandibular joints
Loss of teeth; rheumatoid arthritis
Correction of bite; surgery in some
Idiopathic or granulomatous lesion of cavernous sinus or superior orbital fissure
Compression of common carotid at or below bifurcation reproduces pain
Tumors, granulomatous lesions, Injuries In parasellar region
Occasionally with cranial arteritis, carotid tumor, migraine and cluster headache
Ergotamine acutely; methyserglde for prevention provoked by consumption of alcohol. A chronic form, recurring daily for many years without respite, is known.
Cluster headaches can by treated with single doses of ergotamine at bedtime (for nocturnal attacks) or once or twice during the day, in anticipation of a headache. Inhalation of 100% oxygen aborts most attacks. Once the diagnosis has been established, some physicians turn directly to a course of prednisone, beginning with 60 to 75 mg daily and reducing the dose at 3-day intervals, unless the headaches reappear. In chronic cases, lithium carbonate (600 to 900 mg daily, with blood levels of 0.7 to 1.2 meq/L) or indomethacin may be effective.
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