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Paroxysmal Hemicrania: An Update.

Vimal Kumar Paliwal1, Ravi Uniyal2

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Summary
This summary is machine-generated.

Paroxysmal Hemicrania (PH) is a rare headache disorder. Indomethacin is key for diagnosis, and understanding its features aids differentiation from other headaches.

Keywords:
Chronic paroxysmal hemicraniacluster headachehemicrania continuaparoxysmal hemicraniatrigeminal autonomic cephalalgia

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Area of Science:

  • Neurology
  • Headache Medicine

Background:

  • Paroxysmal Hemicrania (PH) is a rare trigeminal autonomic cephalalgia (TAC).
  • Understanding of PH has evolved since its initial description in 1974.
  • Diagnostic criteria and management have been refined over time.

Purpose of the Study:

  • To review major case series of PH.
  • To describe the epidemiology and clinical features of PH.
  • To provide recent updates on PH diagnosis and management.

Main Methods:

  • Tabulation of major PH case series.
  • Review of epidemiological and clinical data.
  • Analysis of diagnostic criteria and treatment outcomes.

Main Results:

  • PH involves daily, short-lasting, unilateral headaches with autonomic symptoms.
  • Restlessness is a newly added diagnostic criterion.
  • Complete response to indomethacin is essential for PH diagnosis.
  • PH must be distinguished from cluster headache and SUNCT/SUNA.

Conclusions:

  • PH pathophysiology involves trigeminal afferents and trigeminal-autonomic reflex.
  • Hypothalamic involvement is suggested by recent functional imaging.
  • Indomethacin is the primary treatment; alternatives exist for intolerance.
  • Deep brain stimulation is an option for refractory cases.