Snapshot A 36-year-old man presents with recurrent bouts of left-sided severe lancinating periorbital pain. His symptoms began 20 minutes prior, and appears to occur daily for the past several weeks. During his headache episodes, he constantly tears, and has a “runny nose.” Miosis, ptosis, and conjunctival injection is appreciated on exam. Introduction Primary headache disorder characterized by login to view 4 more bullets A type of trigeminal autonomic cephalalgias (TACs) Typically lasts 15-180 minute login to view 1 more bullet Epidemiology More common in men Onset typically 10 - 39 years old Presentation Symptoms login to view 5 more bullets Differential Migraine headache Trigeminal neuralgia DIAGNOSIS Clinical diagnosis Treatment Treatment Acute (Abortive) Therapy Preventive Prophylactic Therapy 100% O2 Triptans Verapamil Lithium Melatonin Complications Medication overuse headaches Prognosis Affects quality of life As a person ages, frequency may decline