1. A 16-year-old girl comes to the pediatrician's office with recurrent headaches (at least 25 episodes in the last 2-3 months). She describes the pain as retro-orbital, usually occurring around her right eye. The pain is sharp and sometimes feels like stabbing. Each episode typically lasts about 5 to 30 minutes but never last anytime more than 60 minutes, during which she notices redness of the conjunctiva and swelling around the right eye and a runny nose. On days when she has headaches, there can be more than 10 episodes in a single day. During the episodes, she feels very restless and paces around the room. There is no associated nausea or vomiting, and she does not experience photophobia or phonophobia. Based on this information, what is the likely diagnosis for this 16-year-old?
2. A 17-year-old boy comes to the pediatrician’s office with near-continuous right-sided headache that waxes and wanes in intensity throughout the day. This has been present for the last 3 months. The pain is localized to the right periorbital and retro-orbital regions, with some radiation to the temporal areas. The headaches are associated with redness of the right eye, intermittent lacrimation, and a runny nose. At times, at the peak of the headaches, his eyelid appears swollen, and there is often associated right forehead and facial sweating. He feels on edge and is very restless, especially when the pain worsens. Based on this information, what is the most likely diagnosis?
Based on the above information, what would be an appropriate next step in evaluation and diagnostics?
3. A 13-year-old boy comes to the office with complaints of infrequent episodes (5 over the last year) of headaches. The headaches are described as severe unilateral retro-orbital pain, lasting 15 minutes to 60 minutes, and are associated with unilateral conjunctival injection, lacrimation, eyelid edema, miosis, or ptosis. During the episodes, he is very restless and at times agitated. His physical examination is unremarkable. Based on the history, you are concerned about him having cluster headaches. What is the appropriate evaluation, as well as acute and preventive strategies for cluster headaches in children?
