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Headache Disorders
Published in Sahar Swidan, Matthew Bennett, Advanced Therapeutics in Pain Medicine, 2020
Chronic paroxysmal hemicrania is a rare syndrome marked by headaches of short duration, a high frequency of attacks, and associated autonomic symptoms. CPH pain location is normally orbital, temporal, and above or behind the ear and is one-sided. The pain is severe in intensity. Normal headache duration is between 2 and 30 minutes and frequency is greater than five attacks per day. Unlike cluster headache, there is no predilection for nocturnal attacks, although attacks can certainly awaken a patient from sleep. Associated symptoms are marked by autonomic phenomena. CPH attacks can sometimes be triggered by rotating the neck or flexing the head to the side of the headaches, or by applying external pressure to the transverse processes of C4–C5 or the C2 nerve root on the symptomatic side. This syndrome used to be termed female cluster headache but it is not cluster headache based on the frequency and duration of attacks, and a misdiagnosis can lead to continued disability as indomethacin is not suggested for CH but is for CPH. Hemicrania Continua
Neurology
Published in Shibley Rahman, Avinash Sharma, A Complete MRCP(UK) Parts 1 and 2 Written Examination Revision Guide, 2018
Shibley Rahman, Avinash Sharma
Paroxysmal hemicrania is characterised by multiple, brief, intense, daily focal head pain attacks. The pain is unilateral and always affects the same side. The pain is usually most severe in the auriculotemporal area, the forehead and above or behind the ear. It may spread to involve the ipsilateral shoulder, arm and neck. The pain is described as excruciating, throbbing, boring or pulsating. Between attacks, the patient may have tenderness in the symptomatic area.
Diagnosis and Management of Facial Pain
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Rajiv K. Bhalla, Timothy J. Woolford
This is a severe debilitating unilateral headache affecting usually the periorbital and frontotemporal regions, with an average age of onset of 30 to 40 years. Attacks are usually short-lasting, ranging from 2 to 45 minutes, and frequent, happening more than 5 times a day. Trigeminal autonomic symptoms may include nasal congestion, rhinorrhoea and lacrimation, lending itself to diagnostic confusion. The majority of patients with paroxysmal hemicrania respond to indomethacin within 24 hours. In cases where indomethacin fails to work, other drugs that have been suggested include calcium-channel blockers, naproxen, carbamezapine, and sumatriptan.
Tolerability of pharmacological agents in the treatment of headache following brain injury: a scoping review
Published in Brain Injury, 2023
Heather M. MacKenzie, Michael Robinson, Amanda McIntyre
There were more female (n = 88) than male (n = 68) subjects overall; two studies (21,22) did not report sex (Table 1). Most studies (N = 9) reported a mean age between 29 and 49 years old. One study (21) did not report age and the other (22) provided an age range of 13–18 years. Incidentally, articles studied only subjects with mild traumatic brain injury (mTBI) (N = 10), with the exception of one case report (16) where the subject experienced a period of loss of consciousness lasting at least 30 minutes in duration, which is in keeping with a moderate severity TBI (2). The full spectrum of time post TBI was reflected in the included articles: <4 weeks (n = 33), 1–6 months (n = 74), 6–12 months (n = 21), and >12 months (n = 63). Another 50 subjects (20) were studied during the first 12 weeks post injury, and 15 subjects (23) were studied 1–12 months post injury. One study (22) did not report on time post TBI. The most common headache phenotype was migraine (n = 12) (14,18), but the articles also reported on individuals with hemicrania continua (n = 5) (13,15), and chronic paroxysmal hemicrania (n = 1) (16). The headache phenotype was not described for the majority of participants (89%, n = 286).
Neuromodulation for the treatment of primary headache syndromes
Published in Expert Review of Neurotherapeutics, 2019
Tso et al. [13]. explored the potential efficacy of nVNS in indomethacin-sensitive trigeminoautonomic cephalalgias (TAC), namely chronic paroxysmal hemicrania and hemicrania continua. All observed patients were responsive to indomethacin but either had to reduce or even discontinue the treatment due to adverse effects so that in this study in some patients nVNS was used as a monotherapy, in some as an add-on therapy to indomethacin used at the maximum tolerated dose. Of the nine patients with hemicrania continua and the six patients with chronic hemicrania continua had a significant improvement of their condition while only four patients (two with hemicrania continua and two with chronic paroxysmal hemicrania) had no response to nVNS [13]. Sham-controlled studies are clearly needed to confirm these findings.
Beyond chronic migraine: a systematic review and expert opinion on the off-label use of botulinum neurotoxin type-A in other primary headache disorders
Published in Expert Review of Neurotherapeutics, 2021
Andreas A. Argyriou, Dimos-Dimitrios Mitsikostas, Elisa Mantovani, Michail Vikelis, Stefano Tamburin
Primary headaches (PHs) are those occurring without any underlying cause, structural lesion, or discrete causative factor. According to the most recent iteration of the International Classification of Headache Disorders, Third Edition (ICHD-3) [1], the four PH categories are 1) migraine (with or without aura), 2) tension-type headache (TTH), 3) cluster headache (CH) and other trigeminal autonomic cephalalgias (TACs), including paroxysmal hemicrania, hemicrania continua (HC), short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache with cranial autonomic features syndrome (SUNA), and 4) other primary headache disorders (Table 1).