Headache

Paroxysmal Hemicrania

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Paroxysmal Hemicrania

  • Classification
  1. Short duration
  2. Trigeminal Autonomic Cephalgia
    1. Headaches similar to Cluster Headache
    2. Unilateral trigeminal distribution symptoms with autonomic features
  • Symptoms
  1. Severity
    1. Severe pain
  2. Characteristics
    1. Unilateral orbital, supraorbital or temporal Headache
  3. Timing
    1. Duration of 2-30 minutes
    2. Recurs more than 5 times daily on >50% of days
  4. Palliative
    1. Relieved with Indomethacin (unlike Cluster Headaches which are not relieved with Indomethacin)
  5. Associated Symptoms (at least one of the following autonomic symptoms characteristic of Cluster Headaches)
    1. Lacrimation
    2. Ipsilateral forehead or facial Flushing or sweating
    3. Ipsilateral Nasal Discharge
    4. Affected eye red with dilated Conjunctival vessels (Conjunctival injection)
    5. Restlessness, pacing or rocking head in hands
    6. Horner's Syndrome (30% of cases)
      1. Ipsilateral Ptosis
      2. Ipsilateral pupillary constriction (Miosis)
  • Differential Diagnosis
  • Management