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What is Paroxysmal hemicranial headache?

Paroxysmal hemicrania (PH) is characterized by frequent unilateral, severe, short-lasting episodes of headache. Like cluster headache,the pain in PH tends to be retroorbital but may sometimes experienced all over the head and it is associated with autonomic phenomena such as lacrimation and nasal congestion. 
The essential features of PH are given below
  • Unilateral, very severe pain; short-lasting attacks (2–45 min) 
  • Very frequent attacks (usually more than five a day) 
  • Marked autonomic features ipsilateral to the pain
  • Rapid course (<72 h)
  • There is excellent response to indomethacin.
Paroxysmal hemicranias may be 
1.Episodic PH-Patients with remissions are said to have episodic PH, 
2. Chronic PH whereas those with the nonremitting form are said to have chronic PH.
In contrast to cluster headache, which predominantly affects males, the male:female ratio in paroxysmal hemicranias  is close to 1:1.
Treatment of PH
Indomethacin (25–75 mg tid) is the treatment of choice.it can completely suppress attacks of PH
Topiramate is helpful in some cases of PH. 
Piroxicam has been used, but it is not as effective as indomethacin. 
Verapamil, a useful drug for treatment for cluster headache, does not appear to be useful for PH.
In some patients, PH can coexist with trigeminal neuralgia (PH-tic syndrome); similar to cluster-tic syndrome, each component of it may require separate treatment.
Secondary Paroxysmalhemicrania
Secondary PH has been reported with lesions situated  in the region of the sellaturcica, such as 
  • Arteriovenous malformation
  • Cavernous sinus meningioma
  • Epidermoid tumors.
Secondary PH is more likely if the patient requires high doses (>200 mg/d) of indomethacin.
In patients with apparent bilateral PH, raised CSF pressure should be suspected. One point to be kept in mind  is that indomethacin can reduces CSF pressure. When a diagnosis of PH is considered, MRI brain  is indicated to exclude a pituitary lesion.