II. Classification

  1. Short duration
  2. Trigeminal Autonomic Cephalgia
    1. Headaches similar to Cluster Headache
    2. Unilateral trigeminal distribution symptoms with autonomic features

III. 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)

IV. Diagnosis

  1. Characteristics: At least 20 or more Headaches meeting the following criteria
    1. Severe to very severe unilateral orbital, supraorbital or temporal pain lasting 2-30 minutes
    2. Headaches >5 times daily
    3. Prevented by therapeutic Indomethacin doses 150 to 225 mg in divided dosing per day
    4. Headache with at least one of the following ipsilateral autonomic symptoms
      1. Conjunctival injection or Lacrimation
      2. Nasal congestion or Rhinorrhea
      3. Eyelid Edema
      4. Forehead and facial sweating
      5. Miosis or Ptosis
      6. Restlessness or Agitation
  2. Timing
    1. Episodic
      1. Two or more cluster periods lasting 7-365 days and separated by pain-free remissions >3 month
    2. Chronic
      1. Episodes recur for more than 1 year without remission or with remission <3 month
  3. References
    1. (2018) Cephalgia 38(1):1-211 [PubMed]

V. Differential Diagnosis

VI. Management

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Related Studies

Ontology: Paroxysmal Hemicrania (C1399352)

Definition (MSH) A primary headache disorder that is similar to the CLUSTER HEADACHE with unilateral head pain, but differs by its multiple short severe attacks. It is usually seen in females, and may be responsive to non-steroidal-anti-inflammatory drugs (NSAIDS).
Concepts Disease or Syndrome (T047)
MSH D051302
ICD10 G44.03
SnomedCT 443094001
Swedish Paroxysmal hemikrani
Czech paroxysmální hemikranie, paroxyzmální hemikranie
Finnish Kohtauksittainen migreeni
English paroxysmal hemicrania (diagnosis), paroxysmal hemicrania, Paroxysmal hemicrania, Paroxysmal hemicrania (disorder), Paroxysmal hemicrania NOS, Paroxysmal Hemicrania [Disease/Finding], Paroxysmal hemicrania (headache one side of head), hemicrania; paroxysmal, paroxysmal; hemicrania, Hemicranias, Paroxysmal, Paroxysmal Hemicranias, Paroxysmal Hemicrania, Hemicrania, Paroxysmal
Spanish hemicránea paroxística (trastorno), hemicránea paroxística, Hemicránea Paroxística
Polish Hemikrania napadowa
Japanese 発作性片頭痛-慢性, 片頭痛-反復性発作性, 発作性片頭痛, 発作性片頭痛-反復性, 発作性片側頭痛, 反復性発作性片側頭痛, 反復性発作性片頭痛, 片頭痛-発作性-反復性, 片頭痛-発作性-慢性, 慢性発作性片頭痛, 慢性発作性片側頭痛, 片頭痛-発作性
Norwegian Paroksysmal hemikrani
Portuguese Enxaqueca Paroxística, Hemicrania Paroxística
Dutch hemicrania; paroxysmaal, paroxysmaal; hemicrania
German Paroxysmale Hemikranie
Italian Emicrania parossistica
French Hémicrânie paroxystique