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Related Experiment Videos

Orbital myositis posing as cluster headache.

Michael S Lee1, Simmons Lessell

  • 1Massachusetts Eye and Ear Infirmary, Department of Neuro-ophthalmology, 243 Charles St, Boston, MA 02114, USA. michael_lee@meei.harvard.edu

Archives of Neurology
|April 10, 2002
PubMed
Summary

Recurrent orbital myositis can mimic cluster headaches for years. Prompt diagnosis requires considering orbital myositis in atypical cluster headache presentations with proptosis and painful eye movements.

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Area of Science:

  • Neuro-ophthalmology
  • Neurology

Background:

  • Cluster headaches are a primary headache disorder characterized by severe unilateral orbital, supraorbital, or temporal pain.
  • Recurrent orbital myositis, an inflammatory condition affecting extraocular muscles, can present with varied symptoms.

Observation:

  • A 24-year-old man experienced recurrent episodes of unilateral supraorbital pain, lacrimation, conjunctival hyperemia, nasal congestion, proptosis, and painful eye movements over six years.
  • Initial symptoms were misdiagnosed as cluster headaches, with attacks responding to prednisone.
  • Neuroimaging revealed an enlarged extraocular muscle, suggesting an inflammatory etiology.

Findings:

  • The patient's prolonged misdiagnosis highlights the significant overlap in clinical presentation between recurrent orbital myositis and cluster headaches.

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  • The key differentiating features included persistent proptosis, painful eye movements, and pain that did not fully resolve within the typical cluster headache timeframe.

    • Implications:

    • Orbital myositis should be included in the differential diagnosis for patients presenting with atypical cluster headache features.
    • Early recognition of orbital myositis can prevent delayed diagnosis and ensure appropriate treatment, avoiding prolonged misdiagnosis of debilitating headache disorders.