Paroxysmal hemicrania

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By Peter J Goadsby MD PhD

Dr Goadsby from UCSF reviews paroxysmal hemicrania, one of the trigeminal autonomic cephalalgias. The short attack length (typically 20 minutes), high frequency of attacks (often 10 per day), and associated cranial autonomic features (such as lacrimation, conjunctival injection, and nasal symptoms), should trigger the diagnosis to be considered. When paroxysmal hemicrania is considered, investigation for pituitary gland pathology with dedicated MRI and blood tests is recommended, based on large case series. Paroxysmal hemicrania is absolutely responsive to indomethacin when it is tolerated at doses from 25 to 275 mg daily.

Key points

  • Paroxysmal hemicrania is a unilateral, severe, short-lasting headache, typically of 20 minutes duration and occurring approximately 10 times a day.
  • Paroxysmal hemicrania attacks are associated with cranial autonomic symptoms, such as lacrimation, conjunctival infection, and nasal symptoms.
  • Paroxysmal hemicrania responds absolutely to indomethacin given orally.
  • It is recommended that any patient with a diagnosis of paroxysmal hemicrania undergo investigation by MRI and blood tests for pituitary gland dysfunction.