A new (?) Clinical headache entity "chronic paroxysmal hemicrania" 2

Abstract

A headache disorder with shortlasting, frequently occurring (6-18/24 hours) head pain attacks is reported. The pain is excruciatingly severe, unilateral (always on the same side), unaccompanied by visual phenomena, nausea/vomiting, but accompanied by nasal congestion and lacrimation on the symptomatic side. The maximum pain is felt in the temporal region, although during severe attacks the entire hemicranium is involved through the neck, shoulder and homolateral arm in a diffuse way. The attack pattern differs clearly from that of cluster headache both with regard to atrack frequency and the long term temporal pattern. In addition to blood and urine parameters and supplementary neurological/neuroradiological investigations, the following parameters were studied: Urinary histamine excretion (partly increased), kinin parameters (occasionally increased blood kinin and reduced blood kininogen), and corneal indentation pulse amplitudes (attack-induced increase, as in regular cluster headache). The following parameters rendered normal results: prostaglandins, cerebral blood flow, fluorescein appearance time, intrathecal pressure during and between attacks, and muscle biopsy with immunological investigation. The pain attacks can be abolished by continuous indomethacin medication. In spite of the ocular findings it has in common with cluster headache, this headache seems to differ from cluster headache.