Paroxysmal hemicrania

Paroxysmal hemicrania manifests itself in attacks with pain characteristics and accompanying symptoms similar to those of cluster headache. Distinctive symptoms are the short duration of attacks and their high frequency. Paroxysmal hemicrania is more often observed in women, the disease usually begins in adulthood, but cases in children have also been described. A specific feature of this form of cephalgia is the effectiveness of indomethacin. Diagnostic criteria are presented below.

Paroxysmal hemicrania (ICGB-4)

• A. At least 20 seizures meeting criteria for BD.
• B. Attacks of intense unilateral pain in the orbital, supraorbital or temporal localization lasting 2-30 minutes.
• C. The headache is accompanied by at least one of the following symptoms:
  • ipsilateral conjunctival injection and/or lacrimation;
  • ipsilateral nasal congestion and/or rhinorrhea:
  • ipsilateral eyelid edema;
  • ipsilateral sweating of the forehead and face;
  • ipsilateral miosis and/or ptosis.
• D. The predominant frequency of attacks is more than five times a day, sometimes a little less often.
• E. Attacks are completely prevented by taking indomethacin in a therapeutic dose.
• F. Not associated with other causes (disorders).

As with cluster hunger pain, a distinction is made between episodic (with remissions of 1 month or more) and chronic forms of paroxysmal hemicrania, in which attacks recur for more than 1 year without remissions or with remissions of less than 1 month. There are known cases of paroxysmal hemicrania combined with trigeminal neuralgia (the so-called paroxysmal hemicrania-tic syndrome).

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Treatment of paroxysmal hemicrania

Specific therapy for paroxysmal hemicrania is the use of indomethacin (orally or rectally at a dose of at least 150 mg/day or at least 100 mg as an injection). For maintenance therapy, smaller doses are often effective.