Question:
A 30-year-old woman presents with a unilateral throbbing headache associated with photophobia, phonophobia, and osmophobia. Each episode lasts for 4-6 hours and improves with rest. What is the most likely diagnosis?
A 30-year-old woman presents with a unilateral throbbing headache associated with photophobia, phonophobia, and osmophobia. Each episode lasts for 4-6 hours and improves with rest. What is the most likely diagnosis?
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Remember the diagnostic criteria for Migraine without aura (the "5-4-3-2-1" rule):
$\geq$ 5 attacks
Lasting 4 to 72 hours
$\geq$ 2 characteristics (unilateral, pulsating, moderate/severe, worsened by activity)
$\geq$ 1 associated symptom (nausea/vomiting, or photophobia + phonophobia).
$\geq$ 5 attacks
Lasting 4 to 72 hours
$\geq$ 2 characteristics (unilateral, pulsating, moderate/severe, worsened by activity)
$\geq$ 1 associated symptom (nausea/vomiting, or photophobia + phonophobia).
Updated On: Sep 3, 2026
- SUNCT (Short-lasting Unilateral Neuralgiform headache with Conjunctival injection and Tearing)
- Paroxysmal hemicrania
- Cluster headache
- Migraine
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The Correct Option is D
Solution and Explanation
Concept:
Primary headache disorders are classified primarily based on the character, duration, location of the pain, and associated autonomic or systemic symptoms.
The presentation provided is the quintessential textbook description of a Migraine headache.
Explanation:
• Migraines are common primary headaches characterized by recurrent attacks of moderate to severe pain.
• The classic characteristics include: a unilateral location, a pulsating or throbbing quality, aggravation by routine physical activity, and a duration typically ranging from 4 to 72 hours if left untreated.
• Crucially, migraines are accompanied by significant associated sensory sensitivities, most notably nausea/vomiting, photophobia (sensitivity to light), phonophobia (sensitivity to sound), and osmophobia (sensitivity to smells).
• The patient's presentation perfectly matches these criteria: unilateral, throbbing, lasting 4-6 hours, with photo/phonophobia.
• Option (A), SUNCT, is a Trigeminal Autonomic Cephalalgia (TAC). It features excruciating unilateral eye pain but is extremely brief, lasting only seconds to a few minutes, and is accompanied by prominent autonomic symptoms (tearing, red eye).
• Option (B), Paroxysmal hemicrania, is another TAC characterized by severe, unilateral pain localized around the eye, but attacks are shorter (2-30 minutes) and occur multiple times a day, also accompanied by autonomic features. It is uniquely responsive to Indomethacin.
• Option (C), Cluster headache, occurs mostly in males, causes severe "ice-pick" orbital pain, lasts 15-180 minutes, and causes the patient to be restless and agitated, unlike migraineurs who prefer to lie quietly in a dark, quiet room.
Final answer:
The combination of unilateral throbbing pain, a duration of hours, and sensitivity to sensory stimuli definitively points to a Migraine.
Primary headache disorders are classified primarily based on the character, duration, location of the pain, and associated autonomic or systemic symptoms.
The presentation provided is the quintessential textbook description of a Migraine headache.
Explanation:
• Migraines are common primary headaches characterized by recurrent attacks of moderate to severe pain.
• The classic characteristics include: a unilateral location, a pulsating or throbbing quality, aggravation by routine physical activity, and a duration typically ranging from 4 to 72 hours if left untreated.
• Crucially, migraines are accompanied by significant associated sensory sensitivities, most notably nausea/vomiting, photophobia (sensitivity to light), phonophobia (sensitivity to sound), and osmophobia (sensitivity to smells).
• The patient's presentation perfectly matches these criteria: unilateral, throbbing, lasting 4-6 hours, with photo/phonophobia.
• Option (A), SUNCT, is a Trigeminal Autonomic Cephalalgia (TAC). It features excruciating unilateral eye pain but is extremely brief, lasting only seconds to a few minutes, and is accompanied by prominent autonomic symptoms (tearing, red eye).
• Option (B), Paroxysmal hemicrania, is another TAC characterized by severe, unilateral pain localized around the eye, but attacks are shorter (2-30 minutes) and occur multiple times a day, also accompanied by autonomic features. It is uniquely responsive to Indomethacin.
• Option (C), Cluster headache, occurs mostly in males, causes severe "ice-pick" orbital pain, lasts 15-180 minutes, and causes the patient to be restless and agitated, unlike migraineurs who prefer to lie quietly in a dark, quiet room.
Final answer:
The combination of unilateral throbbing pain, a duration of hours, and sensitivity to sensory stimuli definitively points to a Migraine.
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