Chronic paroxysmal hemicrania (CPH). The clinical manifestations. A review

Abstract

Eight definite and 10 possible cases of CPH are known to the authors. Decisive diagnostic features in the differential diagnosis versus ordinary cluster headache (Horton's headache) seem to be: the presence of headache every day, a high maximum daily attack frequency (greater than or equal to attacks/24 hours) and an absolute indomethacin effect. There is increasing evidence for a female preponderance in CPH. It emerges from this study that there frequently (or invariably?) is a pre-CPH stage with atypical attack pattern, usually lasting several years. Pregnancy seems to have a rather clear ameliorating effect on attack frequency and severity. In other patients, the very onset of headache is immediately after delivery. The importance of recognizing this special headache from a clinical point of view is clear since this disabling disorder can be completely abolished by drug therapy.