A3.2 Paroxysmal hemicrania (alternative criteria)

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
      • forehead and facial flushing
      • sensation of fullness in the ear
      • miosis and/or ptosis
      • 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 A3.2 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:

Opinion is divided on inclusion of (e) and (f) in criterion C1. Experts in the working group believe it improves sensitivity without significant loss of specificity, but formal field testing has not been performed to support the change in criteria.