3.2 Paroxysmal hemicrania

Description:

Attacks of severe, strictly unilateral pain which is orbital, supraorbital, temporal or in any combination of these sites, lasting 2-30 minutes and occurring several or many times a day. The attacks are usually associated with ipsilateral conjunctival injection, lacrimation, nasal congestion, rhinorrhoea, forehead and facial sweating, miosis, ptosis and/or eyelid oedema. They respond absolutely to indomethacin.

Diagnostic criteria:
  1. At least 20 attacks fulfilling criteria B-E
  2. Severe unilateral orbital, supraorbital and/or temporal pain lasting 2-30 minutes
  3. Either or both of the following:
    1. at least one of the following symptoms or signs, ipsilateral to the headache:
      • – conjunctival injection and/or lacrimation
      • – nasal congestion and/or rhinorrhoea
      • – eyelid oedema
      • – forehead and facial sweating
      • – miosis and/or ptosis
    2. a sense of restlessness or agitation
  4. Occurring with a frequency of >5 per day1
  5. Prevented absolutely by therapeutic doses of indomethacin2
  6. Not better accounted for by another ICHD-3 diagnosis.
Notes:
  1. During part, but less than half, of the active time-course of 3.2 Paroxysmal hemicrania, attacks may be less frequent.
  2. In an adult, oral indomethacin should be used initially in a dose of at least 150 mg daily and increased if necessary up to 225 mg daily. The dose by injection is 100-200 mg. Smaller maintenance doses are often employed.
Comment:

In contrast to cluster headache, there is no male predominance. Onset is usually in adulthood, although