oa Intermittent headache and swelling in the temple

A 32-year old female patient was referred to our hospital for evaluation of headache. A preliminary diagnosis of possible temporal arteritits in young patient was made in the referral letter. She had been complaining of episodes of left sided headache for the last 2 years. The headache occurred mainly in the horning; it is mild to moderate in severity, associated with feeing of fullness in the left temple. The episodes were coming at no regular time, was not related to menstruation and was not accompanied by nausea, vomiting or photophobia. It lasts for few hours and then subsides, and she noticed that the sensation of fullness also disappears. She had no history of trauma. She denied any fever, weight loss, morning stiffness, or any sinuses, ear or eye complaints. She was diagnosed at one time as migraine headache and was given treatment for that. Clinical examination at the time of headache revealed afebrile patient with normal blood pressure and pulse. The left temple showed fullness compared to the right side but there was no redness or warmth of the overlying skin. There was an ill-defined slightly raised 5 × 4cm soft swelling in the left temple. There was no palpable thrill or audible bruit. The temporal artery was pulsating without any tenderness.