Paroxysmal hemicrania

Abstract

Paroxysmal hemicrania (PH) is a primary headache disorder belonging to the group of trigeminal autonomic cephalalgias(TACs). Patients typically experience intense lateralzsed headaches with pain primarily in the ophthalmic trigeminal distribution (V1) associated with superimposed ipsilateral cranial autonomic features. PH is distinguished from other TACs by an exquisite responsiveness to therapeutic doses of indomethacin. Patients may need to be maintained on indomethacin for several months before trials of reduction can be attempted. The disorder does have a tendency toward chronicity. PH is uncommon, but early recognition will prompt initiation of effective treatment to avoid unsuccessful trials of drugs effective in other primary headaches. As with other TACs, hypothalamic and trigeminovascular mechanisms are implicated in the pathophysiologic mechanism of PH. Neuroimaging findings in PH demonstrate a posterior hypothalamic activation similar to that observed in the other TACs. This review will address the epidemiology, clinical presentation, pathophysiology, evaluation, and treatment of PH.

Cluster Headache and Other Trigeminal Autonomic Cephalalgias

“…Unlike cluster headache, attacks of paroxysmal hemicrania tend not to be triggered by alcohol but rather can be triggered by neck movements. Paroxysmal hemicrania is believed to account for about 5% of all TACs 49 . As with cluster headache, paroxysmal hemicrania can be divided into episodic and chronic forms based on the duration of remission periods, if present.…”

Are repetitive pericranial nerve blocks effective in the management of chronic paroxysmal hemicrania?

“…Indomethacin is a nonsteroidal anti-inflammatory drug with potent analgesic and anti-inflammatory activity used as acute and preventative treatment for PH headache since the 1960s. [5] Furthermore, the diagnosis of PH is clinically supported by a response to indomethacin. [1] Even though indomethacin is inexpensive and easy to administer, the side effects associated with indomethacin such as gastrointestinal bleeding, coagulation disorders, renal dysfunction, and hypertension may limit its use.…”