What is Chronic Paroxysmal Hemicrania (Severe One Sided Headaches Lasting for at least One Year)?
Chronic paroxysmal hemicrania (CPH) is a type of headache disorder that causes repeated one-sided headaches paired with symptoms linked to nerve responses in the head. These headaches are usually severe and can happen more than five times a day, even up to forty times in certain cases. Symptoms that come with the headaches include tears in the affected eye, redness in the eyes, a blocked nose, a runny nose, blushing in the face, eyelid swelling, pupil dilation or constriction, excessive sweating, or feeling like your ear is blocked. Attacks, on average, last 26 minutes but can range from two minutes to almost two hours. These happen during both daytime and night time and usually on the same side in the majority (more than 95%) of patients.
What separates CPH from episodic paroxysmal hemicrania is that there’s no break in pain or the breaks don’t last more than three months. A medication called indomethacin can treat paroxysmal hemicrania effectively, eliminating symptoms in most patients.
CPH belongs to a group of headache disorders named trigeminal autonomic cephalgias (TACs). These are characterized by pain in the distribution area of the trigeminal nerve (a key nerve in your head and face), alongside similar nerve-related symptoms as CPH. This group also includes disorders like cluster headaches, hemicrania continua, and short-lasting unilateral neuralgiform headache attacks with tearing eyes and redness.
The international classification of headache disorders lays out very specific criteria for a CPH diagnosis. These include more than twenty attacks with no period of relief, or periods of relief that last less than three months at least over a year. The pain usually happens in the areas around or above the eye or the temples and lasts for 2 to 30 minutes. Either one or both sets of symptoms must occur: either one or more of the symptoms listed earlier happening on the same side as the headache or a feeling of restless or agitation. The attacks must occur more than five times per day. They must be entirely preventable by therapeutic doses of indomethacin, and no other disorder should better account for the symptoms.
What Causes Chronic Paroxysmal Hemicrania (Severe One Sided Headaches Lasting for at least One Year)?
The cause of chronic paroxysmal hemicrania (CPH), a type of severe headache, is not yet known. Some people with CPH have reported a history of head or neck injuries, however, this is also seen in people suffering from migraines, suggesting that there could be a shared link. To date, there haven’t been any reports indicating that CPH runs in families.
CPH can be triggered by movements like bending or twisting your neck. Applying external pressure against certain parts of the spine (specifically the C4-C5 vertebrae, the C2 nerve root, or the larger nerve at the back of your head) can also provoke these headaches.
Risk Factors and Frequency for Chronic Paroxysmal Hemicrania (Severe One Sided Headaches Lasting for at least One Year)
Chronic paroxysmal hemicrania, a rare and often undiagnosed condition, affects a small percentage of people. This condition can affect anyone and tends to be more common in women. On average, it generally starts around the age of 37.
- Chronic paroxysmal hemicrania is a rare condition, thought to be often undiagnosed.
- About 1% of the population in Norway is estimated to have this condition according to one study.
- A review of various studies showed that roughly 1.7% of patients in a neurology headache clinic are diagnosed with paroxysmal hemicrania.
- Both males and females are equally likely to have episodic paroxysmal hemicrania, but females are more commonly diagnosed with the chronic form.
- Chronic paroxysmal hemicrania can start at any age, but the average age of onset is around 37, according to a study of 84 patients.
Signs and Symptoms of Chronic Paroxysmal Hemicrania (Severe One Sided Headaches Lasting for at least One Year)
Diagnosing chronic paroxysmal hemicrania, a type of headache, fundamentally depends on a careful review of the patient’s health history. When dealing with this condition, the character of the headache (sharp and stabbing), how long it lasts (between 2 to 30 minutes), and accompanying features tied to the nerves in the head (cranial autonomic features) are essential clues.
Generally, these headache attacks come on out of the blue. However, in about 10% of patients, turning their head can set off an attack. During an attack, a physical exam might disclose signs on one side of the face such as increased tear production, reddening of the eye, swelling around the eye, droopy eyelids, unusually small or large pupils, and sweating.
There may be a tender feeling when the area around the eye and temple is touched on one side during an attack. Apart from these, the neurological exam of the patient should be normal. If anything abnormal is detected in the neurological examination, it would be appropriate to consider further tests, including brain imaging.
Testing for Chronic Paroxysmal Hemicrania (Severe One Sided Headaches Lasting for at least One Year)
Diagnosing primary chronic paroxysmal hemicrania (CPH), a type of headache, involves gathering a detailed medical history and observing the patient’s response to a medication called indomethacin. There isn’t a specific lab test or imaging technique that can directly diagnose CPH. Instead, these tools can help rule out other potential causes of the headache.
When it comes to pictures of the brain using techniques like magnetic resonance imaging (MRI) or computed tomography (CT), people with primary CPH usually show no abnormalities. These imaging methods can help confirm that the CPH isn’t caused by some structural problem in the brain, which would classify it as secondary chronic paroxysmal hemicrania.
Doctors also might check levels of substances in the blood, like erythrocyte sedimentation rate and C-reactive protein. If these are high, it could suggest a condition called giant cell arteritis, but they are generally normal in CPH cases.
Secondary paroxysmal hemicrania (a headache caused by another condition), can be triggered by various factors like abnormal blood vessels, stroke, tumor, injury, high pressure within the skull, or diseases involving connective tissue.
Treatment Options for Chronic Paroxysmal Hemicrania (Severe One Sided Headaches Lasting for at least One Year)
Indomethacin, a type of anti-inflammatory medication, is commonly prescribed as the initial treatment for a type of chronic headache known as chronic paroxysmal hemicrania (CPH). Typically, taking this medication either in 25 mg or 50 mg doses three times a day can successfully prevent CPH attacks. Indomethacin can also help to prevent other types of headaches including paroxysmal hemicrania, hemicrania continua, primary cough headache, and primary stabbing headache.
However, it’s important to understood that prolonged use of Indomethacin could increase the risk of stomach ulcers. As such, a type of medication called a proton pump inhibitor is often suggested to protect the stomach while using Indomethacin. Ideally, Indomethacin should be used for as short a time as possible to prevent potential side effects. Moreover, this medication should not be used in people with kidney problems or a history of stroke or heart attack.
Alternate treatment options for preventing CPH include medications such as calcium channel blockers, acetazolamide, topiramate, melatonin, and corticosteroids. However, these alternatives are generally less effective than Indomethacin.
Treatment methods like pericranial nerve blocks are not found to be effective in treating chronic paroxysmal hemicrania. But non-invasive stimulation of the vagus nerve, a long cranial nerve that runs from the brain to the abdomen, has shown positive results in a small group of CPH patients.
What else can Chronic Paroxysmal Hemicrania (Severe One Sided Headaches Lasting for at least One Year) be?
Chronic paroxysmal hemicrania (CPH) is a headache condition that can often be confused with other types of chronic headaches. However, CPH is unique and requires different treatments. Here are some other conditions doctors might consider when diagnosing CPH:
- Trigeminal neuralgia is a condition that causes sudden bursts of pain in the areas of the face served by the trigeminal nerve. However, it doesn’t present with the certain features that accompany CPH.
- Temporal arteritis is a condition that primarily causes headaches near the temples, in addition to pain when touching the area, changes in vision in only one eye, and higher than normal rates of inflammation indicators in the blood.
- Trigeminal autonomic cephalgias, a family of headache disorders which includes CPH, are characterized by headaches accompanied by certain features related to the nerves in the head. One of these, the cluster headache, differs from CPH in that it happens less frequently (about once to eight times a day) and responds well to specific treatments not effective for CPH.
Another condition, referred to as SUNCT (short-lasting unilateral neuralgiform headache attacks with conjunctival injection), also involves one-sided headaches and accompanying features similar to CPH. However, these headaches occur more frequently, last a shorter time, and respond well to a different treatment than CPH.
What to expect with Chronic Paroxysmal Hemicrania (Severe One Sided Headaches Lasting for at least One Year)
People with chronic paroxysmal hemicrania (CPH), a type of headache, have a high chance of recovery when they receive a correct diagnosis and are treated with indomethacin, a specific medicine. However, if they can’t tolerate indomethacin or have health conditions that make it unsuitable, their headaches may become more debilitating. As of now, no deaths or severe health complications have been reported due to CPH.
Life stages and factors like pregnancy, menstrual cycles, menopause, or birth control pills do not seem to affect the progression of CPH.
Possible Complications When Diagnosed with Chronic Paroxysmal Hemicrania (Severe One Sided Headaches Lasting for at least One Year)
Chronic paroxysmal hemicrania (CPH) is a medical term for a very painful headache that only affects one side of the head. Sometimes, the treatment of CPH can lead to complications. The preferred medicine for treating CPH is Indomethacin. However, it can aggravate peptic ulcer disease and kidney problems. Moreover, it can increase the chances of blood clot events that could harm the heart’s cardiovascular system.
Common Side Effects of Indomethacin:
- Exacerbation of peptic ulcer disease
- Renal (kidney) insufficiency
- Increased risk of heart-related blood clot events
Preventing Chronic Paroxysmal Hemicrania (Severe One Sided Headaches Lasting for at least One Year)
Patients should understand the signs and symptoms of a group of headaches called trigeminal autonomic cephalgias, which includes a specific type known as chronic paroxysmal hemicrania (CPH). Recognizing the specific timing, type of pain, and related symptoms of these headaches can help healthcare providers accurately diagnose and treat the condition. Different types of these headaches respond to different treatments. Therefore, distinguishing between these headache types is crucial for reducing symptoms and feeling better.
