Neuro Disorders: Chronic Paroxysmal Hemicrania

Introduction

Chronic Paroxysmal Hemicrania (CPH) is a type of primary headache (HA) condition.

It is called Primary HA because there are no structural brain pathologies or any kind of systemic problems to explain its occurrence.

Who gets this HA?

There is no predilection for any race or ethnicity. It is more frequent during adulthood. Women are affected more often than men.

Clinical Presentation

Most of the attacks are unilateral. Region in and around the eye, frontal & temporal area are commonly involved. Attacks can occur anytime although day time attacks are more frequent than night time.

The duration is not very long, most of the attacks last less than an hour. On an average they last for 15 to 30 minutes.

Patients can experience multiple episodes on the same day.

Autonomic manifestations like reddening of conjunctiva, excessive tear and/or nasal secretion production, constriction of pupil, eyelid swelling and/or drooping are seen along with HA.

Diagnosis

As primary HA the investigations are expected to come normal. If diagnosis is uncertain a CT or MRI with and without contrast is justified.

Treatment

For acute attacks indomethacin is the treatment of choice. Other NSAIDs like Naproxen, diclofenac, celecoxib etc are tried too. These agents are generally used with gastric protectors like misoprostol, H2 blockers, antacids, proton pump inhibitors etc.

For prevention of future attacks (those who get frequent episodes) again indomethacin can be tried and preferably on small doses. Some other choices include verapamil, topiramate etc.

A neurologist is frequently involved in the care of patients with CPH.



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