Trigeminal autonomic cephalgia caused by recurrent posterior scleritis

Area of Science:

• Ophthalmology
• Neurology

Background:

• Trigeminal autonomic cephalgias (TACs) are a group of primary headache disorders.
• Differential diagnosis of TACs includes secondary causes and other neurological conditions.

Observation:

• A 40-year-old woman experienced headaches with autonomic features that shifted sides.
• The patient showed atypical features including side-swapping and abnormal optic disc appearances.

Findings:

• The patient had a partial response to indometacin, an anti-inflammatory medication.
• The clinical presentation ultimately led to a diagnosis of recurrent posterior scleritis.

Implications:

• This case highlights the importance of considering posterior scleritis in the differential diagnosis of TACs.
• Recognizing atypical presentations is crucial for accurate diagnosis and management of headache disorders.