Abstract
BackgroundCluster headache is a primary condition characterized by severe headache accompanied by trigeminal autonomic signs. By definition, it is not attributed to underlying etiologies; however, under certain clinical characteristics, secondary etiologies must be ruled out.Case presentationWe present the case of a 48-year-old Hispanic man with a history of episodic right orbital pain, lasting 30 minutes, associated with ipsilateral tearing, who prior to the onset of his symptoms reported loss of appetite, weight loss, and paresthesias in the right chin region. After work-up studies, high-grade lymphoma with infiltration to the right submental nerve was diagnosed, in which numb chin syndrome was the initial presentation. Despite initiation of treatment, the patient died 3 weeks after the diagnosis.ConclusionsIn the study of cluster headache, underlying etiologies must be considered when there are atypical clinical manifestations. Within these etiologies, metastases to pericranial nerves must be included, which, besides generating localized symptoms, can activate the trigeminal vascular system simulating headaches of primary etiology.
Highlights
Cluster headache is a primary condition characterized by severe headache accompanied by trigeminal autonomic signs
We report a case in which high-grade lymphoma with invasion to the submental nerve was diagnosed, with a manifestation of numb chin syndrome and symptomatic cluster headache
We found a 4-month history of high-severity, 30-minute right orbital pain episodes associated with ipsilateral tearing without residual pain, as often as two to eight attacks per day; precipitating factors were not identified
Summary
In the study of cluster headache, underlying etiologies must be considered when there are atypical clinical manifestations. Metastases to pericranial nerves must be included, which, besides generating localized symptoms, can activate the trigeminal vascular system simulating headaches of primary etiology
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