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paroxysmal hemicrania
Epidemiology:
1) rare
2) generally begins in adulthood
3) more common in women than men
Clinical manifestations:
1) severe throbbing, claw-like, or boring pain usually on one side of the face in, around, or behind the eye
2) occasional reaches the back of the neck
3) red & tearing eyes
4) a drooping or swollen eyelid on the affected side of the face
5) nasal congestion
6) dull pain, soreness, or tenderness may occur between attacks
7) two forms:
a) chronic: attacks on a daily basis for a year or more
b) episodic: headaches may remit for months or years
8) movements of the head or neck or external pressure to the neck may trigger these headaches
Management:
1) indomethacin often provides complete relief from symptoms
- responds dramatically & specifically to indomethacin [1]
2) other NSAIDs are less effective
3) calcium-channel blockers (verapamil) & corticosteroids have been used
5) patients with both paroxysmal hemicrania & trigeminal neuralgia should receive treatment for each disorder
Prognosis:
1) many patients experience complete resolution of symptoms
2) condition may persist indefinitely, may go into remission or resolve spontaneously
General
trigeminal autonomic cephalgia
References
- Medical Knowledge Self Assessment Program (MKSAP) 16
American College of Physicians, Philadelphia 2012
- Goadsby PJ, Cittadini E, Cohen AS.
Trigeminal autonomic cephalalgias: paroxysmal hemicrania,
SUNCT/SUNA, and hemicrania continua.
Semin Neurol. 2010 Apr;30(2):186-91
PMID: 20352588
- NINDS Paroxysmal Hemicrania Information Page
https://www.ninds.nih.gov/Disorders/All-Disorders/Paroxysmal-Hemicrania-Information-Page