Chronic paroxysmal hemicrania: orbital phlebography and steroid treatment. A case report

A 62-year-old man with ankylosing spondylitis and with a 3-year history of chronic paroxysmal hemicrania is presented. Because of his ankylosing spondylitis naproxen was prescribed; this decreased the attacks of headache to about 50%. However, treatment with indomethacin and steroids eliminated the attacks completely, the former drug in 24 h but only when the drug was taken; the latter drug was completely effective after a week but with an effect that lasted half a year after the medication was stopped. Orbital phlebography showed changes similar to those previously observed in patients with Tolosa-Hunt syndrome and cluster headache. Venous vasculitis thus seems to be associated with all three disorders and may be a factor of etiologic significance.