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A 61-year-old woman was admitted to our headache outpatient center with a 6-month history of headache attacks occurring every night. She had no history of other types of headache or any other neurological diseases. There was no family history of headache. The attacks always occurred between 1 and 3 o’clock, and the duration was no longer than 120 min. She experienced one attack per night. The pain quality was described as tightness and pressure, always right sided with mild to moderate intensity (3–6/10 on a visual analogue scale). There was no nausea or vomiting, no photophobia, or phonophobia. After waking up, she has the habit to walk around; however, headache did not worsen by that physical activity. Trigemino-autonomic symptoms, such as ptosis, miosis, conjunctival injection, tearing, and rhinorrhea, were absent. General, as well as neurological, examination was normal. The trapezius muscles were mildly pain sensitive to finger pressure. Blood pressure was normal. Routine blood tests only showed moderately high levels of cholesterol (total cholesterol 277 mg/dL, LDL cholesterol 162 mg/dL), as well as slightly elevated liver enzymes (alanine transaminase (ALT) 47, aspartate transaminase (AST) 41). Numerous treatments, such as aspirin, paracetamol, diclofenac, and several mixed analgesics, failed to improve their headache attacks. She suffered from extreme psychological strain, because of severe sleep disturbances. Lorazepam, used as a sleep-inducing drug, did not abort the headache attacks.
KeywordsCluster Headache Trapezius Muscle Headache Attack Aspartate Transaminase Intracranial Hypotension