Chronic Paroxysmal Hemicrania in a Patient with a Macroprolactinoma

We report a patient with headaches meeting the criteria of chronic paroxysmal hemicrania, as defined by the International Headache Society classification. Headaches were fully responsive to indomethacin during the first 3 months of treatment but recurred when daily doses were lowered. Investigations revealed a macroprolactinoma. Headaches stopped after cabergoline treatment. This report further suggests that patients with paroxysmal hemicrania should be investigated for pituitary abnormalities.

Download Full-text

Neuropeptide Changes in a case of Chronic Paroxysmal Hemicrania—Evidence for Trigemino-Parasympathetic Activation

Cephalalgia ◽

10.1046/j.1468-2982.1996.1606448.x ◽

1996 ◽

Vol 16 (6) ◽

pp. 448-450 ◽

Cited By ~ 113

Author(s):

P J Goadsby ◽

L Edvinsson

Keyword(s):

Cluster Headache ◽

Vasoactive Intestinal Polypeptide ◽

Successful Treatment ◽

International Headache Society ◽

Paroxysmal Hemicrania ◽

Related Peptide ◽

Calcitonin Gene ◽

Autonomic Activation ◽

Chronic Paroxysmal Hemicrania ◽

Underlying Pathophysiology

Chronic paroxysmal hemicrania (CPH) is a rare headache syndrome of short-lasting attacks of pain, characterized clinically by trigemino-parasympathetic activation. The features of the headache are severe attacks of pain that generally last no more than minutes in association with autonomic activation, such as lacrimation or rhinorrhea. We report a patient fulfilling International Headache Society guidelines for the diagnosis of CPH in whom levels of calcitonin gene-related peptide (CGRP) and vasoactive intestinal polypeptide (VIP) were elevated in the cranial circulation during attacks. Moreover, successful treatment of the problem with indomethacin leads to normalization of the levels of both CGRP and VIP. Given that similar neuropeptide changes are seen in cluster headache the data suggest a shared underlying pathophysiology between CPH and cluster headache.

Download Full-text

Alcohol-induced headaches: Evidence for a central mechanism?

Journal of Neurosciences in Rural Practice ◽

10.4103/0976-3147.178654 ◽

2016 ◽

Vol 07 (02) ◽

pp. 269-275 ◽

Cited By ~ 6

Author(s):

Alessandro Panconesi

Keyword(s):

International Headache Society ◽

Primary Headache ◽

Familial Hemiplegic Migraine ◽

Tension Type Headache ◽

Hemicrania Continua ◽

Paroxysmal Hemicrania ◽

Primary Headaches ◽

Study Approach ◽

Type Headache ◽

International Headache Society Classification

ABSTRACTAlcoholic drinks (ADs) have been reported as a migraine trigger in about one-third of the migraine patients in retrospective studies. Some studies found that ADs trigger also other primary headaches. The studies concerning the role of ADs in triggering various types of primary headaches published after the International Headache Society classification criteria of 1988 were reviewed, and the pathophysiological mechanisms were discussed. Many studies show that ADs are a trigger of migraine without aura (MO), migraine with aura (MA), cluster headache (CH), and tension-type headache (TH). While data on MO and CH are well delineated, those in MA and TH are discordant. There are sparse reports that ADs are also triggers of less frequent types of primary headache such as familial hemiplegic migraine, hemicrania continua, and paroxysmal hemicrania. However, in some countries, the occurrence of alcohol as headache trigger is negligible, perhaps determined by alcohol habits. The frequency estimates vary widely based on the study approach and population. In fact, prospective studies report a limited importance of ADs as migraine trigger. If ADs are capable of triggering practically all primary headaches, they should act at a common pathogenetic level. The mechanisms of alcohol-provoking headache were discussed in relationship to the principal pathogenetic theories of primary headaches. The conclusion was that vasodilatation is hardly compatible with ADs trigger activity of all primary headaches and a common pathogenetic mechanism at cortical, or more likely at subcortical/brainstem, level is more plausible.

Download Full-text

Paroxysmal Hemicrania in Children—Symptoms, Diagnostic Criteria, Therapy and Outcome

Cephalalgia ◽

10.1111/j.1468-2982.2008.01813.x ◽

2009 ◽

Vol 29 (8) ◽

pp. 873-882 ◽

Cited By ~ 22

Author(s):

M Blankenburg ◽

T Hechler ◽

G Dubbel ◽

C Wamsler ◽

B Zernikow

Keyword(s):

Case Reports ◽

International Headache Society ◽

Pain Clinic ◽

Paroxysmal Hemicrania ◽

Validated Questionnaires ◽

Follow Up Study ◽

Patient Pain ◽

International Headache Society Classification

Whereas paroxysmal hemicrania (PH) is studied extensively in adults, even case reports of PH in children are rare. We present the first prospective follow-up study on PH in children. Our aim was to investigate whether differences exist between paediatric and adult patients. We assessed all children with chronic headache who were referred to our paediatric out-patient pain clinic within 3 years based on interviews and validated questionnaires. Among 628 patients we found five children with PH (0.8%) and three with probable PH (0.5%), in total 1.3%. Pain characteristics, autonomic symptoms and treatment response to indomethacin were similar to adult PH patients. Our results demonstrate that the International Headache Society classification of PH is also applicable to children. We suspect that PH has been underdiagnosed in children and therefore suboptimally treated thus far.

Download Full-text

Chronic Paroxysmal Hemicrania, Hemicrania Continua and Sunct Syndrome in Association with Other Pathologies: A Review

Cephalalgia ◽

10.1111/j.1468-2982.2003.00646.x ◽

2004 ◽

Vol 24 (3) ◽

pp. 173-184 ◽

Cited By ~ 63

Author(s):

M Trucco ◽

F Mainardi ◽

F Maggioni ◽

R Badino ◽

G Zanchin

Keyword(s):

Causal Relationship ◽

Diagnostic Criteria ◽

Case Reports ◽

International Headache Society ◽

Hemicrania Continua ◽

Paroxysmal Hemicrania ◽

Trigeminal Autonomic Cephalalgias ◽

Sunct Syndrome ◽

Associated Lesions ◽

Chronic Paroxysmal Hemicrania

We present a review of 22 cases of headache mimicking chronic paroxysmal hemicrania (CPH) (17 female and five male; F : M ratio 3.4), nine cases mimicking hemicrania continua (HC) (seven female and two male) and seven cases mimicking SUNCT syndrome (five male and two female) found in association with other pathologies published from 1980 up to the present. All case reports were discussed with respect to diagnostic criteria proposed by International Headache Society (IHS) for CPH, by Goadsby and Lipton for HC and SUNCT, and evaluated to identify a possible causal relationship between the pathology and the onset of headache. The aim of the present review was to evaluate if the presence of associated lesions and their location could help elucidate the pathogenesis of trigeminal autonomic cephalalgias (TACs).

Download Full-text

Dose, Efficacy and Tolerability of Long-Term Indomethacin Treatment of Chronic Paroxysmal Hemicrania and Hemicrania Continua

Cephalalgia ◽

10.1046/j.1468-2982.2001.00287.x ◽

2001 ◽

Vol 21 (9) ◽

pp. 906-910 ◽

Cited By ~ 61

Author(s):

JA Pareja ◽

AB Caminero ◽

E Franco ◽

JL Casado ◽

J Pascual ◽

...

Keyword(s):

Hemicrania Continua ◽

Paroxysmal Hemicrania ◽

Chronic Paroxysmal Hemicrania ◽

Indomethacin Treatment

Download Full-text

Chronic Paroxysmal Hemicrania. VII. Mechanical Precipitation of Attacks: New Cases and Localization of Trigger Points

Cephalalgia ◽

10.1046/j.1468-2982.1984.0402113.x ◽

1984 ◽

Vol 4 (2) ◽

pp. 113-118 ◽

Cited By ~ 11

Author(s):

Ottar Sjaastad ◽

Carsten Saunte ◽

JR Graham

Keyword(s):

Posterior Part ◽

Transverse Process ◽

Trigger Points ◽

Paroxysmal Hemicrania ◽

Sensitive Area ◽

Manual Pressure ◽

Chronic Paroxysmal Hemicrania ◽

Local Tenderness ◽

Symptomatic Side

Two new chronic paroxysmal hemicrania patients are described. In both, attacks can be precipitated mechanically by applying firm manual pressure to certain sensitive points on the neck, i.e. in the C2 area, in the transverse processes of the C4–C5 vertebrae, or beneath the posterior part o15 the skull on the symptomatic side. The most sensitive area seems to be the transverse process of C4–C5. Susceptibility to this type of attack is dependent on the flow of spontaneous attacks; attacks are easily precipitated in a phase with multiple spontaneous attacks, but are not readily precipitated otherwise. Under indomethacin protection, local tenderness is clearly diminished and attacks cannot be precipitated.

Download Full-text

Chronic Paroxysmal Hemicrania: Salivation, Tearing and Nasal Secretion

Cephalalgia ◽

10.1046/j.1468-2982.1984.0401025.x ◽

1984 ◽

Vol 4 (1) ◽

pp. 25-32 ◽

Cited By ~ 6

Author(s):

C Saunte

Keyword(s):

Salivary Glands ◽

Nasal Secretion ◽

Test Battery ◽

The Other ◽

Paroxysmal Hemicrania ◽

Control Group ◽

Innervation Pattern ◽

Autonomic Functions ◽

Chronic Paroxysmal Hemicrania ◽

The One

Autonomic functions have been studied in seven patients with chronic paroxysmal hemicrania (CPH). A test battery comprising tearing, salivation and nasal secretion was employed. Under basal conditions these parameters did not differ significantly from those in a control group. After stimulation with pilocarpine the patients responded rather inhomogeneously. This test battery may therefore help find and classify subgroups of these types of patients. During attacks, there is a clear discrepancy between minimal salivation on the one hand and the marked increase in tearing, nasal secretion and sweating on the other. CPH attacks may be associated with an increased firing of sympathetic impulses to the different organs. In the event of a uniform type of autonomic firing taking place during attack, these findings may suggest a different innervation pattern for the salivary glands compared to the other glands involved. The innervation pattern of these secretory organs may seem to be more intricate and sophisticated than hitherto assumed.

Download Full-text