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What is Paroxysmal Hemicrania?
Written by Medicover Team and Medically Reviewed by Dr Prachi Rahul Pawar , Neurologist
Paroxysmal hemicrania is a rare type of chronic headache disorder marked by sudden, severe pain on one side of the head, usually around the eye or temple. The attacks are short but frequent, often lasting 2 to 30 minutes and can happen several times a day.
Key Features:
- Always affects one side of the head
- Sharp, stabbing pain that comes in short bursts
- Often linked with eye redness, tearing, or nasal congestion
- More common in adults, especially women
What Makes It Unique?
Paroxysmal hemicrania responds very well to a specific medication called indomethacin. This strong response helps doctors confirm the diagnosis.
What are the Types of Paroxysmal Hemicrania?
Paroxysmal hemicrania is classified based on how often and how long the attacks occur. There are two main types:
Chronic Paroxysmal Hemicrania (CPH)
- Attacks have occurred daily for at least a year
- No long pain-free periods
- Most common type
- Requires long-term treatment with indomethacin
Episodic Paroxysmal Hemicrania (EPH)
- Attacks happen in clusters (bouts) lasting weeks to months
- Followed by pain-free periods that may last months
- May eventually turn into the chronic form
What are the Symptoms of Paroxysmal Hemicrania?
Paroxysmal hemicrania causes sudden, sharp headaches on one side of the head. These attacks are short but can happen many times a day.
Common Symptoms
- Severe, stabbing pain on one side of the head (usually around the eye or temple)
- Unilateral Pain
- Always affects the same side
- Eye redness or tearing during attacks
- Nasal congestion or runny nose
- Drooping eyelid or small pupil (in some cases)
- Tearing
- Miosis (constriction of the pupil)
- Pain triggered by head movement or neck pressure (occasionally)
Frequency and Duration
Episodes of paroxysmal hemicrania are brief, lasting from 2 to 30 minutes. However, they can occur multiple times per day, sometimes up to 40 times in severe cases.
What are the Causes of Paroxysmal Hemicrania?
The exact cause of paroxysmal hemicrania is not fully understood, but it is believed to involve the hypothalamus, a part of the brain that helps control pain, sleep, and body functions. It may also be linked to abnormal nerve activity in the face and head.
Possible Triggers
While the condition is not caused directly by external factors, certain triggers may bring on an attack:
- Stress
- Alcohol
- Physical exertion
- Bright lights
- Certain foods (e.g., chocolate, processed meats)
- Changes in sleep pattern
What Are The Risk Factors For Paroxysmal Hemicrania?
- More common in adults
- Seen more often in women than men
- May occur with other headache disorders, like migraine or cluster headaches
Even though the cause is unclear, recognizing and avoiding triggers can help reduce the frequency of attacks.
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Get Second OpinionHow is Paroxysmal Hemicrania Diagnosed?
Paroxysmal hemicrania is diagnosed mainly through a detailed medical history, symptom pattern, and a strong response to a specific medication. Since it closely resembles other headache disorders, accurate diagnosis is key.
Diagnostic Steps
- Clinical Evaluation: The doctor will ask about:
- Pain location (always one side)
- Attack duration (2-30 minutes)
- Frequency (multiple times per day)
- Associated symptoms (eye redness, tearing, nasal congestion)
- Indomethacin Test:
- A defining feature of paroxysmal hemicrania is that it responds completely to indomethacin, a type of anti-inflammatory drug.
- If the headaches stop after starting indomethacin, it confirms the diagnosis.
- Neurological Exam: To rule out other causes of head pain or nerve problems
- Imaging (if needed): MRI or CT scan may be done to exclude other brain or vascular conditions if symptoms are unusual or persistent.
An early and accurate diagnosis helps prevent unnecessary tests and ensures the right treatment is started quickly.
What are the Treatment Options for Paroxysmal Hemicrania?
Paroxysmal hemicrania can be well-controlled with proper treatment. The goal is to stop the headache attacks and prevent recurrence. Treatment includes medications, lifestyle changes, and in some cases, supportive therapies.
Indomethacin (Main Treatment)
- A strong anti-inflammatory medicine
- Rapidly stops attacks in most people
- A positive response to indomethacin helps confirm the diagnosis
- May be taken daily, as prescribed by a doctor
Other Medications (if indomethacin isn't suitable)
- Verapamil: A calcium channel blocker, may help reduce attack frequency
- Topiramate: An anticonvulsant that can lower pain intensity
- Gabapentin: Used for nerve pain, may help in some cases
Lifestyle Modifications
- Avoid known triggers like stress, alcohol, and sleep disruptions
- Practice stress relief with relaxation techniques, meditation, or yoga
- Stick to a regular sleep schedule
Physical Therapies
- Acupuncture or massage therapy may offer relief for some people
- Chiropractic care has shown benefits in select cases
- Always consult a doctor before starting any alternative therapy
With proper treatment, especially indomethacin, most patients can manage symptoms and enjoy a good quality of life.
When to See a Doctor for Paroxysmal Hemicrania?
You should see a doctor if you have:
- Repeated, one-sided headaches that come and go quickly
- Severe, stabbing pain around the eye or temple
- Headaches several times a day
- Red or teary eye, stuffy nose, or drooping eyelid with the pain
- No relief from usual painkillers
- A history of migraines or other headache disorders but the pattern has changed
Getting the correct diagnosis early is essential because paroxysmal hemicrania responds very well to a specific treatment (indomethacin). Early care can prevent long-term discomfort and unnecessary tests.
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Paroxysmal Hemicrania vs. Cluster Headache
While paroxysmal hemicrania and cluster headaches may seem similar, they are different conditions that require various treatments. Both belong to a group of headache pain disorders called trigeminal autonomic cephalalgias, but they have key differences.
Duration of Attacks
- Cluster headaches typically last 15 minutes to 3 hours.
- Paroxysmal hemicrania attacks are much shorter, typically 2 to 30 minutes.
Frequency of Attacks
- Paroxysmal hemicrania occurs more often, sometimes several times a day.
- Cluster headaches are usually less frequent, often with a few attacks per day during a cluster period.
Response to Medication
- Paroxysmal hemicrania responds very well to indomethacin, a potent anti-inflammatory medicine.
- Cluster headaches do not respond to indomethacin and are treated differently (e.g., with oxygen or triptans).
Can Paroxysmal Hemicrania Be Prevented?
Paroxysmal hemicrania can't be prevented entirely, as its exact cause is unknown. However, you can reduce the frequency and severity of attacks with the right approach.
Helpful Prevention Tips
- Take prescribed medication (like indomethacin) regularly to keep attacks under control
- Avoid known triggers, such as:
- Stress
- Alcohol
- Irregular sleep
- Bright lights or loud noise
- Maintain a regular sleep routine
- Manage stress through relaxation techniques like yoga or meditation
- Stay hydrated and eat regularly
Management Strategies for Paroxysmal Hemicrania
Managing paroxysmal hemicrania involves more than just taking medication. A combination of medical care, lifestyle modifications, and emotional support can help manage symptoms effectively.
Regular Monitoring
- Visit your doctor regularly to track your symptoms
- Treatment may need adjustments based on how your body responds
- Ongoing checkups help prevent complications and manage side effects
Patient Education
- Learn about your condition and how it behaves
- Know your triggers and how to avoid them
- Take your medication exactly as prescribed, it's key to staying pain-free
Support Groups
- Connect with others who have similar experiences
- Get emotional support and practical tips
- Sharing helps reduce stress and improves coping
With proper support and routine care, most people can effectively manage paroxysmal hemicrania and lead a normal, active life.
Our Experience in Treating Paroxysmal Hemicrania
At Medicover Hospitals, we specialize in diagnosing and managing complex headache disorders, including paroxysmal hemicrania. Our team of neurologists and pain specialists is trained to identify this rare condition quickly and accurately.
We offer:
- Precise diagnosis using clinical assessment and indomethacin trials
- Personalized treatment plans tailored to each patient's symptoms and lifestyle
- 24/7 neurology support for sudden or severe headache episodes
- Ongoing follow-up care to monitor progress and prevent relapse
- Access to physiotherapy, stress counseling, and lifestyle support for long-term relief
Our goal is to help patients return to daily life with minimal pain and maximum confidence. With the right care, paroxysmal hemicrania is not just manageable, it's treatable.
