paroxysmal hemicrania


Summary: A primary headache disorder that is similar to the CLUSTER HEADACHE with unilateral head pain, but differs by its multiple short severe attacks. It is usually seen in females, and may be responsive to non-steroidal-anti-inflammatory drugs (NSAIDS).

Top Publications

  1. Sjaastad O. Chronic paroxysmal hemicrania, hemicrania continua and SUNCT: the fate of the three first described cases. J Headache Pain. 2006;7:151-6 pubmed
    The first patient with chronic paroxysmal hemicrania has been followed for 45 years, and for 33 years with indomethacin treatment. The headache became less severe with time; there was no indomethacin tachyphylaxis...
  2. Blankenburg M, Hechler T, Dubbel G, Wamsler C, Zernikow B. Paroxysmal hemicrania in children--symptoms, diagnostic criteria, therapy and outcome. Cephalalgia. 2009;29:873-82 pubmed publisher
    Whereas paroxysmal hemicrania (PH) is studied extensively in adults, even case reports of PH in children are rare. We present the first prospective follow-up study on PH in children...
  3. Matharu M, Cohen A, Frackowiak R, Goadsby P. Posterior hypothalamic activation in paroxysmal hemicrania. Ann Neurol. 2006;59:535-45 pubmed
    b>Paroxysmal hemicrania (PH) is a severe, strictly unilateral headache that lasts 2 to 30 minutes, occurs more than five times daily, is associated with trigeminal autonomic symptoms, and is exquisitely responsive to indomethacin...
  4. Talvik I, Koch K, Kolk A, Talvik T. Chronic paroxysmal hemicrania in a 3-year, 10-month-old female. Pediatr Neurol. 2006;34:225-7 pubmed
    This is the report of a 3-year, 10-month-old female with classical symptoms of chronic paroxysmal hemicrania and favorable response to indomethacin therapy...
  5. Walcott B, Bamber N, Anderson D. Successful treatment of chronic paroxysmal hemicrania with posterior hypothalamic stimulation: technical case report. Neurosurgery. 2009;65:E997; discussion E997 pubmed publisher
    Chronic paroxysmal hemicrania (CPH) is a rare, unilateral primary headache syndrome. Recent studies suggest hypothalamic dysfunction as the likely cause of CPH...
  6. Sjaastad O, Vincent M. Indomethacin responsive headache syndromes: chronic paroxysmal hemicrania and Hemicrania continua. How they were discovered and what we have learned since. Funct Neurol. 2010;25:49-55 pubmed
    In the indomethacin responsive headaches (IRHs), chronic paroxysmal hemicrania (CPH) and Hemicrania continua (HC), the indomethacin (INDO) response is swift, absolute, and permanent, with moderate doses...
  7. Müller K, Bekkelund S. Hemicrania continua changed to chronic paroxysmal hemicrania after treatment with cyclooxygenase-2 inhibitor. Headache. 2011;51:300-5 pubmed publisher
    Remission of hemicrania continua (HC) and transformation from HC to chronic paroxysmal hemicrania (CPH) are unusual. We report a patient with left-sided HC who, after a period of remission, presented as CPH...
  8. Giffin N. Paroxysmal hemicrania triggered by GTN. Cephalalgia. 2007;27:953-4 pubmed
  9. May A. Update on the diagnosis and management of trigemino-autonomic headaches. J Neurol. 2006;253:1525-32 pubmed
    ..Although TACs are, in comparison with migraine, quite rare, it is nevertheless very important to consider the clinical factor that they are easy to diagnose and the treatment is very effective in most patients. ..

More Information


  1. Castellanos Pinedo F, Zurdo M, Martínez Acebes E. Hemicrania continua evolving from episodic paroxysmal hemicrania. Cephalalgia. 2006;26:1143-5 pubmed
    A 45-year-old woman, who had been diagnosed in our unit with episodic paroxysmal hemicrania, was seen 2 years later for ipsilateral hemicrania continua in remitting form...
  2. Rossi P, Di Lorenzo G, Faroni J, Sauli E. Seasonal, extratrigeminal, episodic paroxysmal hemicrania successfully treated with single suboccipital steroid injections. Eur J Neurol. 2005;12:903-6 pubmed
    This case report describes a case of extratrigeminal, episodic paroxysmal hemicrania with a clear seasonal temporal pattern, successfully treated with repeated single suboccipital steroid injections...
  3. Boes C, Swanson J. Paroxysmal hemicrania, SUNCT, and hemicrania continua. Semin Neurol. 2006;26:260-70 pubmed
    ..The group includes cluster headache, paroxysmal hemicrania, and short-lasting unilateral neuralgiform headache with conjunctival injection and tearing...
  4. Seidel S, Wöber C. Paroxysmal hemicrania with visual aura in a 17-year-old boy. Headache. 2009;49:607-9 pubmed
    We report the case of a 17-year-old boy presenting with a history of recurrent episodes of isolated visual aura later followed infrequently by indomethacin-responsive headache attacks resembling paroxysmal hemicrania.
  5. Prakash S, Dholakia S, Shah K. A patient with chronic cluster headache responsive to high-dose indomethacin: is there an overlap with chronic paroxysmal hemicrania?. Cephalalgia. 2008;28:778-81 pubmed publisher
  6. Seidel S, Lieba Samal D, Vigl M, Wöber C. Clinical features of unilateral headaches beyond migraine and cluster headache and their response to indomethacin. Wien Klin Wochenschr. 2011;123:536-41 pubmed publisher
    ..on unilateral headaches beyond migraine and cluster headache have focussed on certain disorders such as paroxysmal hemicrania, SUNCT and primary stabbing headache...
  7. Goadsby P, Cittadini E, Cohen A. Trigeminal autonomic cephalalgias: paroxysmal hemicrania, SUNCT/SUNA, and hemicrania continua. Semin Neurol. 2010;30:186-91 pubmed publisher
    ..cephalalgias (TACs) are a group of primary headache disorders that include cluster headache (CH), paroxysmal hemicrania (PH), and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing/..
  8. Monzillo P, Nemoto P, Costa A, Rocha A. Paroxysmal hemicrania-tic and Chiari I malformation: an unusual association. Cephalalgia. 2007;27:1408-12 pubmed
    A 54 year-old female has a clinical diagnosis of chronic paroxysmal hemicrania (CPH) according to IHS-criteria (2004) three years ago...
  9. Cittadini E, Matharu M, Goadsby P. Paroxysmal hemicrania: a prospective clinical study of 31 cases. Brain. 2008;131:1142-55 pubmed publisher
    b>Paroxysmal hemicrania is a rare syndrome characterized by repeated attacks of strictly unilateral, severe, short-lasting pain occurring with cranial autonomic features...
  10. Southerland A, Login I. Rigorously defined hemicrania continua presenting bilaterally. Cephalalgia. 2011;31:1490-2 pubmed publisher
    ..In addition, the diagnosis is often delayed secondary to a relatively low incidence and the occurrence of some phenotypic variability as found in previous case series...
  11. Müller K, Bekkelund S. [A woman with unilateral headache]. Tidsskr Nor Laegeforen. 2011;131:693-5 pubmed publisher
    ..Due to non-compliance because of dyspepsia, which delayed the final diagnosis of chronic paroxysmal hemicrania (CPH) for 16, months indomethacin was administered both rectally and orally...
  12. Leone M, Mea E, Genco S, Bussone G. Coexistence of TACS and trigeminal neuralgia: pathophysiological conjectures. Headache. 2006;46:1565-70 pubmed
    ..We report on 2 patients in whom trigeminal neuralgia coexists with the TACs paroxysmal hemicrania and SUNCT...
  13. Lambru G, Matharu M. Management of trigeminal autonomic cephalalgias in children and adolescents. Curr Pain Headache Rep. 2013;17:323 pubmed publisher
    ..The trigeminal autonomic cephalalgias (TACs), which includes cluster headache (CH), paroxysmal hemicrania (PH) and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (..
  14. Dafer R, Hocker S, Kumar R, McGee J, Jay W. Resolution of paroxysmal hemicrania after resection of intracranial meningioma. Semin Ophthalmol. 2010;25:34-5 pubmed publisher
    b>Paroxysmal hemicrania is a trigeminal autonomic cephalalgia first described in 1976, characterized by episodic attacks of excruciating unilateral periorbital and temporal stabbing, pulsatile, craw-like, or boring headaches lasting 2 - 30 ..
  15. Porta Etessam J, Cuadrado M, Rodríguez Gómez O, García Ptacek S, Valencia C. Are Cox-2 drugs the second line option in indomethacin responsive headaches?. J Headache Pain. 2010;11:405-7 pubmed publisher
    b>Paroxysmal hemicrania and hemicrania continua are both indomethacin-responsive headaches. Although indomethacin use to be well tolerated, some patients developed gastrointestinal side effects...
  16. Androulakis X, Krebs K, Ashkenazi A. Hemicrania continua may respond to repetitive sphenopalatine ganglion block: A case report. Headache. 2016;56:573-9 pubmed publisher
    ..SPG block using a local anesthetic may be an effective treatment for patients with HC, specifically for those who cannot tolerate indomethacin, or when this drug is contraindicated. ..
  17. Benoliel R, Eliav E. Primary headache disorders. Dent Clin North Am. 2013;57:513-39 pubmed publisher
    ..The TACs include cluster headache, paroxysmal hemicrania, and short-lasting neuralgiform headache attacks with conjunctival injection and tearing; hemicrania ..
  18. Yablon L, Newman L. Hemicrania continua: a second case in which the remitting form evolved from the chronic form. Headache. 2010;50:1381-3 pubmed publisher
    ..We report the case of a woman with a 15-year history of chronic hemicrania continua, which over time evolved to remitting hemicrania continua. This is the second reported case in the literature documenting this transition. ..
  19. Prakash S, Rathore C. Side-locked headaches: an algorithm-based approach. J Headache Pain. 2016;17:95 pubmed
    ..The diagnostic approach of primary side-locked headache starts once one rule out all the possible secondary headaches. We have discussed an algorithmic approach for both secondary and primary side-locked headaches. ..
  20. Abu Bakar N, Chard D, Matharu M. Bilateral paroxysmal cephalalgia: a novel indomethacin-responsive primary headache syndrome?. Cephalalgia. 2012;32:1005-8 pubmed
    b>Paroxysmal hemicrania (PH) is a primary headache disorder characterised by frequent, short-lasting, very severe, strictly unilateral attacks occurring in association with cranial autonomic features...
  21. Vishwanath M, Jain A, Carley F. Chronic paroxysmal hemicrania presenting as recurrent orbital inflammation. Headache. 2006;46:686-7 pubmed
    ..We report an unusual case of chronic paroxysmal hemicrania (CPH), a rare but well-described variant of cluster headache in a female presenting to an eye department ..
  22. Alonso A, Nixdorf D. Case series of four different headache types presenting as tooth pain. J Endod. 2006;32:1110-3 pubmed
    ..This case series describes four patients, one each with migraine headache, cluster headache, paroxysmal hemicrania, and hemicrania continua, all of which who presented to dentists with the chief complaint of tooth pain...
  23. Pugach N. An unusual form of TAC-TAC sine autonomic phenomena. J Headache Pain. 2008;9:331-2 pubmed publisher
    ..of short-lasting unilateral pain and autonomic phenomena affecting the head, including cluster headache, paroxysmal hemicrania and SUNCT...
  24. Talvik I, Peet A, Talvik T. Three-year follow-up of a girl with chronic paroxysmal hemicrania. Pediatr Neurol. 2009;40:68-9 pubmed publisher
    This is a follow-up report of a girl, 5 years 4 months old, with classic symptoms of chronic paroxysmal hemicrania from the age of 2 years 3 months who had a complete response to indomethacin therapy...
  25. Irimia P, Barbosa C, Martinez Vila E. Paroxysmal hemicrania after carotid aneurysm embolization. Cephalalgia. 2005;25:1096-8 pubmed
  26. Fragoso Y. Black, white and shades of grey: SUNCT or short-lasting chronic paroxysmal hemicrania?. Arq Neuropsiquiatr. 2006;64:575-7 pubmed
    ..there was complete remission of the pain with indomethacin, suggesting that this was a case of chronic paroxysmal hemicrania with unusually short attack duration...
  27. Maggioni F, Palmieri A, Viaro F, Mainardi F, Zanchin G. Menstrual paroxysmal hemicrania, a possible new entity?. Cephalalgia. 2007;27:1085-7 pubmed
  28. Evans R. Bilateral paroxysmal hemicrania with autonomic symptoms: the first case report. Cephalalgia. 2008;28:191-2 pubmed
  29. Graff Radford S. Facial pain. Neurologist. 2009;15:171-7 pubmed publisher
    ..Peripheral and central mechanisms associated with these disorders are used to provide an update of these frequently seen clinical issues. ..
  30. Burns B, Watkins L, Goadsby P. Treatment of hemicrania continua by occipital nerve stimulation with a bion device: long-term follow-up of a crossover study. Lancet Neurol. 2008;7:1001-12 pubmed publisher
    ..The bion device was well tolerated, easily inserted without significant morbidity, and is one-twentieth of the volume of current devices. Such miniaturised devices are a potential new option for treatment of HC. ..
  31. Selekler H, Temel O, Kutlu A. [Episodic paroxysmal hemicrania with seasonal waxing and waning pattern]. Agri. 2010;22:37-40 pubmed
    The chronic form of paroxysmal hemicrania was defined first. Although the episodic form was thought to be inevitably chronic, in time, episodic forms that never reach the chronic phase were identified...
  32. Morelli N, Mancuso M, Felisati G, Lozza P, Maccari A, Cafforio G, et al. Does sphenopalatine endoscopic ganglion block have an effect in paroxysmal hemicrania? A case report. Cephalalgia. 2010;30:365-7 pubmed publisher
    The authors report the case of a 69-year-old woman suffering from paroxysmal hemicrania (PH), intolerant to indomethacin and resistant to multiple therapies, in which sphenopalatine endoscopic ganglion block (SPG) dramatically modified ..
  33. Shah N, Prakash S. Coexistence of cluster headache and paroxysmal hemicrania: does it exist? A case report and literature review. J Headache Pain. 2009;10:219-23 pubmed publisher
    ..We report a 22-year-old male who had cluster headache (CH) and chronic paroxysmal hemicrania (CPH) since the onset of symptoms. Both types of headache responded to indomethacin...
  34. Jurgens T, Schulte L, May A. Indomethacin-induced de novo headache in hemicrania continua--fighting fire with fire?. Cephalalgia. 2013;33:1203-5 pubmed publisher
    ..A treatable secondary origin of the indomethacin-induced headaches in patients with hemicrania continua or paroxysmal hemicrania (such as reversible cerebral vasoconstriction syndrome or aseptic meningitis) should be considered and ..
  35. Noma N, Kamo H, Shimizu K, Plaza Villegas F, Oka S, Imamura Y. Hemicrania continua in a patient with concomitant dental disease. J Am Dent Assoc. 2012;143:1099-103 pubmed
    ..Additional results of our examination led to a diagnosis of HC. Dentists must consider headache disorders in patients who have continuous headaches after undergoing dental treatment for odontogenic pain. ..
  36. Coleman E, Grosberg B, Robbins M. Olfactory hallucinations in primary headache disorders: case series and literature review. Cephalalgia. 2011;31:1477-89 pubmed publisher
    ..We propose that olfactory hallucinations are probably an uncommon but distinctive form of migraine aura, based on their semiology, timing and response to headache prophylaxis. ..
  37. Pego Reigosa R, Vazquez Lopez M, Iglesias Gómez S, Martínez Vázquez F. Association between chronic paroxysmal hemicrania and primary trochlear headache: pathophysiology and treatment. Cephalalgia. 2006;26:1252-4 pubmed
  38. May A. Diagnosis and clinical features of trigemino-autonomic headaches. Headache. 2013;53:1470-8 pubmed publisher
    ..Although TACS are, in comparison to migraine, quite rare, they are nevertheless clinically very important for the neurologist to consider as they are easy to diagnose and the treatment is very effective in most patients. ..
  39. Cuadrado M, Gómez Vicente L, Porta Etessam J, Marcos de Vega M, Parejo Carbonell B, Matías Guiu J. Paroxysmal head pain with backward radiation: will epicrania fugax go in the opposite direction?. J Headache Pain. 2010;11:75-8 pubmed publisher
    ..The symptoms did not fit any of the acknowledged headaches and neuralgias, and might correspond to a reverse variant of EF. ..
  40. Tarantino S, Vollono C, Capuano A, Vigevano F, Valeriani M. Chronic paroxysmal hemicrania in paediatric age: report of two cases. J Headache Pain. 2011;12:263-7 pubmed publisher
    Chronic paroxysmal hemicrania (CPH) is a rare primary headache syndrome, which is classified along with hemicrania continua and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) as ..
  41. Terlizzi R, Cevoli S, Nicodemo M, Pierangeli G, Grimaldi D, Cortelli P. A case of strictly unilateral migraine without aura transformed in an episodic hemicrania continua. Neurol Sci. 2011;32:169-70 pubmed publisher
    ..We report a case of a 42-year-old woman suffered of a remitting form of hemicrania continua evolved from a strictly unilateral migraine without aura. ..
  42. Nicpon K. [Headache induced by oral intake of metoprolol in a patient with chronic and limited cardiac tamponade]. Neurol Neurochir Pol. 2006;40:342-6 pubmed
  43. Silberstein S, Vodovskaia N. Trigeminal autonomic cephalalgias other than cluster headache. Med Clin North Am. 2013;97:321-8 pubmed publisher
    ..b>Paroxysmal hemicrania is a rare headache disorder similar to cluster headache...
  44. Sarov M, Valade D, Jublanc C, Ducros A. Chronic paroxysmal hemicrania in a patient with a macroprolactinoma. Cephalalgia. 2006;26:738-41 pubmed
    We report a patient with headaches meeting the criteria of chronic paroxysmal hemicrania, as defined by the International Headache Society classification...
  45. Prakash S, Belani P, Susvirkar A, Trivedi A, Ahuja S, Patel A. Paroxysmal hemicrania: a retrospective study of a consecutive series of 22 patients and a critical analysis of the diagnostic criteria. J Headache Pain. 2013;14:26 pubmed publisher
    b>Paroxysmal hemicrania (PH) is a probably underreported primary headache disorder...
  46. Oh K, Kim B, Cho S, Park K, Lee D. Concurrent paroxysmal cough and short-lasting hemicrania. Cephalalgia. 2007;27:955-7 pubmed
  47. Cohen A, Matharu M, Goadsby P. Paroxysmal hemicrania in a family. Cephalalgia. 2006;26:486-8 pubmed
    b>Paroxysmal hemicrania (PH) is a trigeminal autonomic cephalgia, characterised by unilateral attacks responsive to indomethacin. There are no published reports of a family history in PH. We report a mother and daughter both with PH...
  48. Gobel H, Gobel C, Heinze A. [Paroxysmal hemicrania and SUNCT]. Schmerz. 2011;25:689-701 pubmed publisher
    b>Paroxysmal hemicrania is experienced as headache attacks with pain and accompanying symptoms similar to those of cluster headaches...
  49. Sjaastad O. Chronic paroxysmal hemicrania: from the index patient to the disease. Curr Pain Headache Rep. 2006;10:295-301 pubmed
    The first patient with chronic paroxysmal hemicrania (CPH), a 41-year-old woman, first seen in 1961, was followed until an adequate treatment was found, 12 years later...
  50. Rozen T. Trigeminal autonomic cephalalgias. Neurol Clin. 2009;27:537-56 pubmed publisher
    ..The TACs include cluster headache, paroxysmal hemicrania, hemicrania continua, and short-lasting unilateral neuralgiform headache attacks with conjunctival ..
  51. Allena M, Tassorelli C, Sances G, Guaschino E, Sandrini G, Nappi G, et al. Is hemicrania continua a single entity or the association of two headache forms? Considerations from a case report. Headache. 2010;50:877-81 pubmed publisher
    ..The analysis of this case raises interesting issues regarding the proper place of HC among the primary headache forms. ..
  52. Peres M, Masruha M, Young W. Side-shifting hemicrania continua with aura (migraine with aura with autonomic symptoms responsive to indomethacin?). Cephalalgia. 2006;26:917-9 pubmed
    ..Side-shifting HC with aura implies the need to revisit the traditional IHS categorization of headaches into unique diagnostic groups. The modular headache theory may be a tool for the understanding of these rare and complex cases. ..
  53. Bekkelund S, Lilleng H. Impact of extreme light exposure during summer season in an arctic area on patients with migraine and chronic paroxysmal hemicrania (CPH). Cephalalgia. 2006;26:1153-6 pubmed