Chronic paroxysmal hemicrania: Difference between revisions

Revision as of 16:29, 16 February 2025

Chronic Paroxysmal Hemicrania

Chronic Paroxysmal Hemicrania (CPH) is a rare primary headache disorder characterized by frequent, short-lasting, and severe unilateral headaches. It is classified under the group of trigeminal autonomic cephalalgias (TACs), which also includes cluster headaches and SUNCT syndrome.

Clinical Features

CPH is marked by attacks of severe pain that are strictly one-sided, typically around the eye, temple, or forehead. These attacks last from 2 to 30 minutes and can occur more than five times a day. The pain is often accompanied by autonomic symptoms such as conjunctival injection, lacrimation, nasal congestion, or rhinorrhea on the affected side.

Pathophysiology

The exact pathophysiology of CPH is not fully understood, but it is believed to involve dysfunction of the hypothalamus and the trigeminal nerve system. The involvement of the facial nerve (cranial nerve VII) is also considered due to the autonomic symptoms observed during attacks.

Diagnosis

Diagnosis of CPH is primarily clinical, based on the characteristic pattern of headache attacks and response to treatment. It is important to differentiate CPH from other TACs and secondary causes of headache. Neuroimaging may be performed to rule out structural lesions.

Treatment

CPH is uniquely responsive to indomethacin, a nonsteroidal anti-inflammatory drug (NSAID). Indomethacin provides complete relief of symptoms in most patients, which is a key diagnostic criterion. Other treatments, such as verapamil or topiramate, are generally ineffective.

Prognosis

With appropriate treatment, the prognosis for individuals with CPH is excellent. Indomethacin effectively controls the attacks, allowing patients to lead normal lives. However, long-term use of indomethacin may be associated with gastrointestinal side effects, necessitating regular monitoring.

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-'''Chronic paroxysmal hemicrania''' (CPH) is a [[neurological disorder]] characterized by severe, unilateral [[headache]] attacks. The condition is a type of [[Trigeminal autonomic cephalalgias|trigeminal autonomic cephalalgia]] (TAC), a group of primary headache disorders that also includes [[cluster headache]] and [[SUNCT syndrome]].
+== Chronic Paroxysmal Hemicrania ==
-== Symptoms ==
+[[File:Cranial_nerve_VII.svg|thumb|right|Diagram of the cranial nerves, including the facial nerve (VII) which may be involved in headache disorders.]]
-The primary symptom of chronic paroxysmal hemicrania is severe, unilateral headache. These headaches are typically located around the [[eye]] or [[temple]], and can be accompanied by other symptoms such as [[tearing]], [[nasal congestion]], and [[eyelid drooping]]. The pain is often described as sharp, stabbing, or throbbing, and can last from 2 minutes to 30 minutes. Attacks can occur up to 40 times a day, and are more common during the day than at night.
-== Causes ==
+'''Chronic Paroxysmal Hemicrania''' (CPH) is a rare primary headache disorder characterized by frequent, short-lasting, and severe unilateral headaches. It is classified under the group of [[trigeminal autonomic cephalalgias]] (TACs), which also includes [[cluster headache]]s and [[SUNCT syndrome]].
-The exact cause of chronic paroxysmal hemicrania is unknown. However, it is thought to involve the [[hypothalamus]], a part of the [[brain]] that regulates many bodily functions, including pain perception. Some researchers believe that CPH may be related to abnormalities in the [[trigeminal nerve]], which is responsible for sensation in the face.
-== Diagnosis ==
+=== Clinical Features ===
-Diagnosis of chronic paroxysmal hemicrania is based on the patient's symptoms and the exclusion of other conditions. The [[International Headache Society]] has established criteria for the diagnosis of CPH, which include the presence of at least 20 attacks of unilateral headache, lasting 2-30 minutes, and occurring more than five times a day for more than half of the time.
+CPH is marked by attacks of severe pain that are strictly one-sided, typically around the eye, temple, or forehead. These attacks last from 2 to 30 minutes and can occur more than five times a day. The pain is often accompanied by autonomic symptoms such as conjunctival injection, lacrimation, nasal congestion, or rhinorrhea on the affected side.
-== Treatment ==
+=== Pathophysiology ===
-Treatment for chronic paroxysmal hemicrania primarily involves medication. The drug of choice is [[indomethacin]], a type of [[nonsteroidal anti-inflammatory drug]] (NSAID). Other treatments may include [[corticosteroids]], [[calcium channel blockers]], and [[anticonvulsants]].
+The exact pathophysiology of CPH is not fully understood, but it is believed to involve dysfunction of the [[hypothalamus]] and the [[trigeminal nerve]] system. The involvement of the [[facial nerve]] (cranial nerve VII) is also considered due to the autonomic symptoms observed during attacks.
-== See also ==
+=== Diagnosis ===
+Diagnosis of CPH is primarily clinical, based on the characteristic pattern of headache attacks and response to treatment. It is important to differentiate CPH from other TACs and secondary causes of headache. Neuroimaging may be performed to rule out structural lesions.
+=== Treatment ===
+CPH is uniquely responsive to [[indomethacin]], a nonsteroidal anti-inflammatory drug (NSAID). Indomethacin provides complete relief of symptoms in most patients, which is a key diagnostic criterion. Other treatments, such as [[verapamil]] or [[topiramate]], are generally ineffective.
+=== Prognosis ===
+With appropriate treatment, the prognosis for individuals with CPH is excellent. Indomethacin effectively controls the attacks, allowing patients to lead normal lives. However, long-term use of indomethacin may be associated with gastrointestinal side effects, necessitating regular monitoring.
+== Related Pages ==
 * [[Cluster headache]]
+* [[Trigeminal neuralgia]]
 * [[SUNCT syndrome]]
-* [[Trigeminal autonomic cephalalgias]]
+* [[Indomethacin]]
+{{Trigeminal autonomic cephalalgias}}
-[[Category:Neurological disorders]]
 [[Category:Headaches]]
-{{neurology-stub}}
+[[Category:Neurology]]