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

Depends on type of lesion

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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