A 30-year-old male complains of unilateral headaches with rhinorrhea and tearing of the eye on the side of the headache. Episodes are precipitated by alcohol. Headaches may become a problem for weeks to months, after which a headache-free period occurs. The most likely diagnosis is
This headache is most consistent with a type of neurovascular headache called cluster headache. These occur most often in young men; have a characteristic periodicity, or cluster; and cause lacrimation, nasal stuffiness, and sometimes conjunctival inflammation. Migraines tend not to come and go in this manner, are more throbbing, and are more likely to be associated with nausea and vomiting. Sinusitis is usually bilateral with associated fever and purulent discharge. Tension headaches are usually described as bandlike, without lacrimation or nasal congestion.