Chronic Paroxysmal Hemicrania

Chronic paroxysmal hemicrania (CPH) is a rare disorder. It has the same characteristics as cluster headache, including similar associated symptoms. These episodes are briefer, more frequent, occur mostly in females, and responsive to indomethacin.

The patient with CPH will characteristically complain of 10-20 brief, intense focal episodes of head pain, localized mostly in the temporal, ocular, frontal, and upper jaw area. The pain has the same quality as cluster headache pain, but of even shorter duration (an average of 10-20 min). CPH attacks are associated with autonomic symptoms and signs that are characteristic for cluster headache. In some patients, head movement or pressure on certain points in the neck can trigger attacks. About 70% of diagnosed patients are female and the mean age of onset is 34 years. The pathogenesis is unknown, but it is considered to be a cluster variant. One of the diagnostic criteria for CPH is absolute responsiveness to indomethacin, an

NSAID. Indomethacin selectively stops the attacks, usually within 2 days of treatment.

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