Paroxysmal Hemicrania

Attacks of severe, strictly unilateral pain which is orbital, supraorbital, temporal or in any combination of these sites, lasting 2-30 minutes and occurring several or many times a day. The attacks are associated with ipsilateral conjunctival injection, lacrimation, nasal congestion, rhinorrhoea, forehead and facial sweating, miosis, ptosis and/or eyelid oedema. They respond absolutely to indomethacin.

Diagnostic criteria:

A. At least 20 attacks fulfilling criteria B-E
B. Severe unilateral orbital, supraorbital and/or temporal pain lasting 2-30 min
C. At least one of the following symptoms or signs, ipsilateral to the pain:

  1. nasal congestion and/or rhinorrhoea
  2. conjunctival injection and/or lacrimation
  3. forehead and facial sweating
  4. eyelid oedema
  5. sensation of fullness in the ear
  6. miosis and/or ptosis
  7. forehead and facial flushing

D. Attacks have a frequency above five per day for more than half of the time
E. Attacks are prevented absolutely by therapeutic doses of indomethacin
F. Not better accounted for by another ICHD-3 diagnosis.

Source

Headache Classification Committee of the International Headache Society (IHS) (2013). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 2013; 33: 9-807.

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