Paroxysmal Hemicrania

Primary Headaches

Paroxysmal Hemicrania

Primary Headaches

What is paroxysmal hemicrania?

Paroxysmal Hemicrania (PH) is similar to but less common then cluster and falls into a category known as “indomethacin responsive headaches.” Unlike cluster headaches, PH is more common in women. There are two forms of this disorder, which include Episodic PH and Chronic PH. In the episodic form, the headache may last up to 4 months before remitting for months and even years. In the chronic form, patients experience daily headaches for a year or more. PH patients have 5-40 headaches per day with an average duration between 2 and 30 minutes. The pain is severe, always one sided and is concentrated around the eye, temple and forehead. It has been described as throbbing, boring, or stabbing.

Other symptoms on the same side of the headache include:

  • Eye watering or redness
  • Nasal congestion or runny nose
  • Decreased size of the pupil
  • Eyelid swelling and/or drooping
  • Forehead perspiration

Other general symptoms include:

  • Light sensitivity
  • Nausea with or without vomiting
  • Slow/fast heart rate

In about 10% of PH sufferers, the headache can be provoked by neck pressure and head movement. In these patients, it is believed that a cervicogenic (neck related) component triggers the PH. This is important, as it provides an additional avenue of treatment for this subset of patients.

How is paroxysmal hemicrania diagnosed?

There is no specific test which will make the diagnosis of PH. The diagnosis is made by a specialist taking a careful history and performing a detailed neurological examination. Because other conditions such tumors and vascular abnormalities can mimic the symptoms of PH, your physician may order imaging studies to exclude these other conditions.

How is paroxysmal hemicrania treated?

By definition, paroxysmal hemicrania always responds to the non- steroidal anti-inflammatory drug, indomethacin (hence it’s classification within the family of indomethacin responsive headaches) which is carefully monitored for potential gastrointestinal and kidney side effects. If it is not tolerated, there are other medications which can be prescribed.

Can Interventional Headache Treatment help with paroxysmal hemicrania?

If you have had prior medical care, a thorough neurological examination, appropriate imaging studies and continue to have headaches which disrupt your regular activities, Interventional Headache Treatment may be an effective way to manage your symptoms.  Through injection procedures, Interventional Headache Treatment can be used to identify the nerve pathways associated with your headache. In some instances the sphenopalatine ganglion is involved and in 10% of patients, it is one of the cervical structures.  Once identified, radiofrequency procedures can be used to provide sustained relief. This and other treatment options will be discussed as part of your initial consultation.

Is a consult appropriate for you?

Please call us to learn more.

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