Chronic Paroxysmal Hemicrania (CPH)

Overview

• Definition: A severe, debilitating unilateral headache affecting half of the head.
• Localization: Commonly localized around the eyes.
• Demographics: More commonly diagnosed in women than in men; can occur at any age, but more common after age 30.
• Comparison with Migraine:
  • Both may involve pain on one side of the head.
  • CPH is different from migraines as it lacks neurological symptoms.

Symptoms

• Frequency: Individuals with CPH experience multiple short, severe headaches daily (often more than five).
• Duration: Most headaches last between 5 and 30 minutes.
• Pattern: Periods of attacks followed by remission (symptom-free days or weeks).
• Chronic Nature: Symptoms persist for longer than a year.

Causes

• Many secondary conditions could potentially cause CPH, including:
  • Aneurysms in the circle of Willis.
  • Middle cerebral artery infarction.
  • Parietal arteriovenous malformation.
  • Malignant frontal tumors.
  • Other pathological conditions.
• Diagnosis: Urgent MRI scans are important to investigate underlying conditions during paroxysmal hemicrania.

Comparison with Cluster Headaches

• Gender Prevalence:
  • CPH is more common in women.
  • Cluster headaches are more common in men.
• Frequency and Duration:
  • CPH attacks are more frequent but shorter.
  • CPH affects all over the head; cluster headaches are more localized.

Treatment

• Indomethacin:
  • Effective management with doses ranging from 25 mg/day to 150 mg/day.
  • Median dose is 75 mg per 24-hour period.
• Topiramate: Found to be an effective treatment as well.

Prevalence

• CPH affects approximately 1 in 50,000 people.
• Cluster headaches affect approximately 1 in 1,000 people.