Paroxysmal Hemicrania

Paroxysmal hemicrania (PH) involves one-sided attacks (headaches) that have closely similar characteristics of pain and associated (autonomic) symptoms of cluster headache (CH). However, they tend to be very much shorter in duration. Each attack normally lasts between 10-30 minutes, but can be as short as two minutes or as long as 45 minutes. They also tend to occur on average more frequently than CH (five per day or more - and sometimes up to 40 per day) and appear to be more prevalent amongst females. As with both CH and migraine there are two variants of PH: chronic and episodic, defined in exactly the same way as in CH.

Like many of the other shorter lasting primary headaches, PH responds almost absolutely to a medication called indomethacin (a non-steroidal anti-inflammatory drug), and it is noteworthy that this course of action is often used as a screening investigation to rule out CH amongst some sufferers.

As with CH, the diagnosis of paroxysmal hemicrania is based purely on assessing the history of the sufferer coupled with a detailed neurological examination.

Source: Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or

Parenteral indomethacin (the INDOTEST) in cluster headache
Authors: Antonaci, F; Costa, A1; Ghirmai, S1; Sances, G2; Sjaastad, O3; Nappi, G4

Source: Cephalalgia, Volume 23, Number 3, April 2003, pp. 193-196(4)

Abstract:

Antonaci F, Costa A, Ghirmai S, Sances G, Sjaastad O & Nappi G. Parenteral indomethacin (the INDOTEST) in cluster headache. Cephalalgia 2003; 23:193-196. London. ISSN 0333-1024

The interval between indomethacin administration and clinical response may be extremely relevant in the assessment of chronic paroxysmal hemicrania (CPH) and other unilateral headache disorders like cluster headache (CH), with which CPH can be confounded. Indomethacin is inactive in CH; however, in some anecdotal reports in recent years, doubt has been cast on the ineffectiveness of indomethacin in CH. In this study, we have re-assessed the effect of indomethacin treatment in a group of 18 patients with episodic CH (three females and 15 males). From the day 8 of the active period, indomethacin 100mg i.m. was administered every 12h, for 2 consecutive days, in an open fashion. The mean daily attack frequency before the test (1.6± 0.6) was not statistically different from that on day 1 (2.1±0.9) and day 2 (1.9±0.8) after indomethacin administration. The mean interval between indomethacin injection and the following attack (day 1 and day 2) was 4.6+1.1h. We did not observe any refractory period in any patient after indomethacin. Since the ‘expected’ attack occurred when there theoretically could have been a protective effect after indomethacin administration, it can be reasonably assumed that there is no such protective effect. The use of a test dose of 100mg i.m. indomethacin (INDOTEST) appears to provide a clear-cut answer in this situation. It may be a useful tool for a proper clinical assessment of unilateral headache with relatively short-lasting attacks when problems of classification arise. A correct diagnosis of CPH or CH is important, since a CPH diagnosis may imply a lifelong treatment with a potentially noxious drug.