Chronic paroxysmal hemicrania

Chronic paroxysmal hemicrania (CPH) is a severe debilitating unilateral headache usually affecting the area around the eye.

CPH headaches are treated through the use of non-steroidal anti-inflammatory drugs, with indomethacin found to be especially effective in eliminating symptoms.

Paroxysmal hemicrania is classified by the characteristic (high) frequency and (short) duration of attacks experienced by patients that is somewhat similar to cluster headaches, despite some important differences explained below.

Dilated blood vessels may contribute in stimulating trigeminal nociceptors directly, although they cannot be the origin of pain, since even suppression of vasodilation does not stop it once it’s started.

These include aneurysms in the circle of Willis, middle cerebral artery infarction, parietal arteriovenous malformation, cavernous sinus and petrous ridge meningiomas, pituitary adenoma, Pancoast tumor, gangliocytoma of the sella turcica, and malignant frontal tumors.

Key differences include: A ten-patient study conducted by Pareja et al. found that all patients diagnosed with CPH were responsive to indomethacin and were able to completely control their symptoms.

[14] According to a case study by Milanlioglu et al., 100 mg of lamotrigine, an antiepileptic drug, administered twice daily alleviated all painful symptoms.

Dosage of lamotrigine was decreased to 50 mg a day after the first two months, and no symptoms or side-effects were recorded after a three-month followup.

The term chronic paroxysmal hemicrania was first used in 1976 by Sjaastad to describe a condition seen in two of their patients who were experiencing repeated solitary and limited daily headache attacks on only one side of the cranium.

Oppermann's report included a 35-year-old woman who had hemicranial pain that lasted for 15 minutes and recurred regularly every hour.