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3D-Neuronavigation In Vivo Through a Patient's Brain During a Spontaneous Migraine Headache

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Recurrent headache mimicking cluster headache: a diagnostic challenge.

Qing Wan¹, Jiayu Wu², Ting Zhang³

¹Emergency Department, Shanghai United Family Hospital, 699 Pingtang Road, Changning District, Shanghai, 200335, China.

Internal and Emergency Medicine

|May 10, 2025

Summary

A patient

Keywords:

Cluster headache Ethmoid sinus mucocele Neuroimaging Secondary headache

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Area of Science:

Neurology
Otolaryngology

Background:

Cluster headache (CH) is a primary headache disorder characterized by severe unilateral head pain.
Trigeminal autonomic cephalalgias (TACs) share similar symptoms with CH, including autonomic features.
Atypical or treatment-resistant headaches warrant investigation for secondary causes.

Purpose of the Study:

To report a case of secondary headache mimicking cluster headache.
To emphasize the diagnostic value of neuroimaging in complex headache presentations.
To highlight the importance of considering structural etiologies in refractory headache cases.

Main Methods:

Case presentation of a 37-year-old male with recurrent headaches.
Clinical evaluation including response to standard CH treatments (oxygen, triptans).
Diagnostic neuroimaging (CT/MRI) to investigate the cause of headache.

Main Results:

Patient presented with symptoms suggestive of cluster headache.
Poor response to high-flow oxygen and triptans indicated a potential secondary cause.
Neuroimaging revealed an ethmoid sinus mucocele causing bone remodeling, mimicking TACs.

Conclusions:

Ethmoid sinus mucocele can present as a secondary headache disorder mimicking trigeminal autonomic cephalalgia.
Surgical management of the mucocele resulted in complete symptom resolution.
This case underscores the necessity of neuroimaging for diagnosing atypical or treatment-resistant headaches.