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Dores de Cabeça à Noite com Rubor Facial: Diagnóstico Diferencial

Recurrent evening cephalgia with flushing suggests several distinct etiologies:

1. Hypertension

Evening BP surge (non-dipper pattern) → headache + facial vasodilation. Check home BP log.

2. Migraine

Autonomic features: flushing, lacrimation, nasal congestion (cranial parasympathetic activation). Often unilateral, throbbing, photophobia.

3. Medication Effects

• Vasodilators (CCBs, nitrates, minoxidil) → flushing + headache.
• Hormonal therapy (estrogen, testosterone).
• Niacin (prostaglandin-mediated flush).

4. Alcohol / Histamine

Alcohol → acetaldehyde + histamine release → flush + headache (especially ALDH2*2 carriers). Tyramine-rich foods (aged cheese, wine) in MAOI users.

5. Carcinoid Syndrome

Serotonin-secreting NET → episodic flush (face/trunk), diarrhea, wheeze, valvular disease. 5-HIAA urine confirms.

6. Menopausal Vasomotor Symptoms

Hot flashes ± headache; evening predominance common.

7. Cluster Headache

Strictly unilateral, periorbital, 15–180 min, nocturnal; ipsilateral lacrimation, rhinorrhea, ptosis, flushing.

8. Pheochromocytoma

Paroxysmal hypertension, headache, sweating, palpitations, pallor/flushing. Plasma free metanephrines.

Action

Headache diary + home BP + basic labs (CBC, CMP, TSH, 5-HIAA if suspected) → targeted referral (neurology, endocrinology, cardiology).