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Case report: Orbital myositis triggering oxygen-responsive cluster headache.

Vivian P Douglas1, Konstantinos Aa Douglas1, Joseph F Rizzo1

  • 1Neuro-Ophthalmology Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA.

Cephalalgia : an International Journal of Headache
|July 27, 2019
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Summary
This summary is machine-generated.

Orbital myositis can mimic cluster headaches, presenting as a rare cause of oxygen-responsive headaches. This case highlights a unique presentation of secondary trigeminal autonomic cephalalgia.

Keywords:
Trigeminal autonomic cephalalgiasdiplopiaperiorbital pain

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Area of Science:

  • Ophthalmology
  • Neurology
  • Headache Medicine

Background:

  • Orbital myositis is an idiopathic, non-infectious inflammatory condition affecting extraocular muscles, typically in young females.
  • It commonly presents with unilateral eye pain, diplopia, and ophthalmoplegia.
  • This condition is often misdiagnosed due to its varied presentations.

Observation:

  • A young woman presented with acute onset headache, periorbital pain, and autonomic symptoms.
  • She experienced vertical diplopia and ocular misalignment, initially diagnosed as cluster headache.
  • Brain MRI was unremarkable, but orbital MRI revealed characteristic inflammatory enhancement of extraocular muscles.

Findings:

  • The patient's headache was responsive to high-flow oxygen therapy.
  • Diagnostic findings confirmed orbital myositis presenting as a secondary trigeminal autonomic cephalalgia.
  • This represents the first reported case of orbital myositis mimicking cluster headache with oxygen responsiveness.

Implications:

  • Orbital myositis should be considered in the differential diagnosis of secondary trigeminal autonomic cephalalgias, especially when headache is oxygen-responsive.
  • Early recognition and appropriate imaging are crucial for accurate diagnosis and management.
  • This case expands the understanding of atypical presentations of orbital myositis and its association with headache disorders.