Thermographic and pupillary asymmetry in chronic paroxysmal hemicrania. A case study

Facial temperature was measured thermographically and pupillary diameter recorded photographically during and between episodes of headache and during spontaneous remission of headache in a patient with chronic paroxysmal hemicrania (CPH). Heat loss from the orbit, nose, cheek and temple was 0.75-1.5 degrees C greater on the symptomatic side during headache, and 0.25-0.75 degrees C greater between headache episodes. Heat loss from these regions of the face was symmetrical during remission of headache. Extensive rhinorrhoea, and slight ptosis and miosis were observed during the active phase of CPH. These findings, which are similar to those previously reported in cluster headache, suggest that CPH is associated with an ocular sympathetic deficit and with overactivity in the greater superficial petrosal nerve.