Refining the clinical spectrum of chronic paroxysmal hemicrania: a review of 74 patients.
OBJECTIVE
To refine the clinical spectrum of chronic paroxysmal hemicrania (CPH).


METHODS
From 1976 to 1996, 74 patients were diagnosed with CPH by Mayo Clinic neurologists. Data were collected on those cases.


RESULTS
Of the 74 patients, 62% were women. Most (93%; 69/74) had strictly unilateral pain, 78% (53/68) had daily attacks, and 4% (2/47) had no autonomic features. The mean usual attack duration was 26 minutes, whereas the mean usual attack frequency was six per day. Three-quarters (30/40) had a consistent response to indomethacin, whereas 25% did not. In 34 patients, there were incomplete data concerning indomethacin response. Some (9/13) were able to stop indomethacin without headache recurrence. Few (2/25) stopped indomethacin because of side effects. Two patients had initial responses to indomethacin that did not persist. Oxygen was beneficial in three patients. Three surgically treatable cases of secondary CPH were identified.


CONCLUSIONS
Attack duration is the clinical feature that best distinguishes CPH from other trigeminal autonomic cephalgias. Although long-term therapy with indomethacin is generally well-tolerated, some patients who clinically appear to have CPH do not respond to indomethacin, and tachyphylaxis may develop in some cases. Some patients are able to stop indomethacin without headache recurrence, highlighting the importance of a trial of discontinuation. A consistent clinical profile and treatment response do not exclude the possibility of intracranial pathology.
Boes
Christopher J
CJ
Department of Neurology, Mayo Clinic, Rochester 55905, MN, USA.
Dodick
David W
DW
D000293:Adolescent; D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D002648:Child; D002908:Chronic Disease; D005260:Female; D020773:Headache Disorders / Q000145:classification / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D007213:Indomethacin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal; D007213:Indomethacin