paroxysmal hemicrania

Epidemiology

• rare
• generally begins in adulthood
• more common in women than men

Clinical manifestations

• severe throbbing, claw-like, or boring pain usually on one side of the face in, around, or behind the eye
• occasional reaches the back of the neck
• red & tearing eyes
• a drooping or swollen eyelid on the affected side of the face
• nasal congestion
• dull pain, soreness, or tenderness may occur between attacks
• two forms:
  • chronic: attacks on a daily basis for a year or more
  • episodic: headaches may remit for months or years
• movements of the head or neck or external pressure to the neck may trigger these headaches

Management

• indomethacin often provides complete relief from symptoms
  • responds dramatically & specifically to indomethacin
• other NSAIDs are less effective
• calcium-channel blockers (verapamil) & corticosteroids have been used
• patients with both paroxysmal hemicrania & trigeminal neuralgia should receive treatment for each disorder

Prognosis:

• many patients experience complete resolution of symptoms
• condition may persist indefinitely, may go into remission or resolve spontaneously

More general terms

• trigeminal autonomic cephalgia

Patient information

paroxysmal hemicrania patient information