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Paroxysmal Hemicrania
Aka: Paroxysmal Hemicrania
- See Also
- Cluster Headache
- Hemicrania Continua
- Short-Lasting Unilateral Neuralgiform Headache Attacks with Conjunctival Injection or Tearing (SUNCT Headache)
- Headache
- Headache Red Flag
- Organic Headache
- Chronic Daily Headache
- Classification
- Short duration
- Trigeminal Autonomic Cephalgia
- Headaches similar to Cluster Headache
- Unilateral trigeminal distribution symptoms with autonomic features
- Symptoms
- Severity
- Severe pain
- Characteristics
- Unilateral orbital, supraorbital or temporal Headache
- Timing
- Duration of 2-30 minutes
- Recurs more than 5 times daily on >50% of days
- Palliative
- Relieved with Indomethacin (unlike Cluster Headaches which are not relieved with Indomethacin)
- Associated Symptoms (at least one of the following autonomic symptoms characteristic of Cluster Headaches)
- Lacrimation
- Ipsilateral forehead or facial Flushing or sweating
- Ipsilateral Nasal Discharge
- Affected eye red with dilated Conjunctival vessels (Conjunctival injection)
- Restlessness, pacing or rocking head in hands
- Horner's Syndrome (30% of cases)
- Ipsilateral Ptosis
- Ipsilateral pupillary constriction (Miosis)
- Diagnosis
- Characteristics: At least 20 or more Headaches meeting the following criteria
- Severe to very severe unilateral orbital, supraorbital or temporal pain lasting 2-30 minutes
- Headaches >5 times daily
- Prevented by therapeutic Indomethacin doses 150 to 225 mg in divided dosing per day
- Headache with at least one of the following ipsilateral autonomic symptoms
- Conjunctival injection or Lacrimation
- Nasal congestion or Rhinorrhea
- Eyelid Edema
- Forehead and facial sweating
- Miosis or Ptosis
- Restlessness or Agitation
- Timing
- Episodic
- Two or more cluster periods lasting 7-365 days and separated by pain-free remissions >3 month
- Chronic
- Episodes recur for more than 1 year without remission or with remission <3 month
- References
- (2018) Cephalgia 38(1):1-211 [PubMed]
- Differential Diagnosis
- See Cluster Headache
- Management
- Indomethacin
- References
- (2004) Cephalgia 24(suppl 1): 9-160 [PubMed]
- Yancey (2014) Am Fam Physician 89(8): 642-8 [PubMed]