MRCP2-3070
A 31-year-old male presents with his 4th episode of worst ever headache in one week. He describes the headache to always be of sudden onset on the left side of his head, of 10 out of 10 severity and that he finds bright lights extremely distressing during these periods. The episodes last for around 30 minutes, typically after dinner. He also describes redness and swelling of his left eye and a blocked left nostril during the headaches, associated with tearing of his left eye.
He has no past medical history and family history of migraines. He denies illicit drug use, is a non-smoker and drinks two glasses of wine with dinner every night. Over the past 7 days, he has been self-medicating with paracetamol and ibuprofen. On examination, you notice no focal neurology, no meningism and fundoscopy is unremarkable.
What is the most likely diagnosis?