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Remitting Chronic Paroxysmal Hemicrania or Episodic Paroxysmal Hemicrania?
Author(s) -
Evans Randolph W.,
Olesen Jes
Publication year - 2000
Publication title -
headache: the journal of head and face pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.14
H-Index - 119
eISSN - 1526-4610
pISSN - 0017-8748
DOI - 10.1111/j.1526-4610.2000.00157.x
Subject(s) - psychology , medicine
CLINICAL HISTORY This 75-year-old woman has a 2-year history of recurring headaches. The first cycle of headaches lasted for about 1 month. Since then, the headaches recur every few months and last about 3 weeks. This recurrence started 3 weeks ago. The headaches almost always occur during the night awakening her from sleep. She describes a left retro-orbital and periorbital severe pressure and stabbing associated with tearing of the left eye, swelling of the left eyelid, and either clear drainage or congestion of the left nares. During the headache, she has to get up and pace and cannot lie or sit still. The headaches last 1 to 2 minutes and can recur about every 2 hours. During the headache periods, the headaches occur zero to four times daily, with an average of about three daily. She had seen other physicians and was tried on lithium as a preventive and butorphanol tartrate nasal spray as symptomatic treatment without benefit. A magnetic resonance imaging scan of the brain was normal. She has a past medical history of essential tremor and a postganglionic Horner syndrome present for 20 years with a negative evaluation. There is also a history of hypertension but no diabetes, ischemic heart disease, or cerebrovascular disease. Neurological examination was normal except for the left Horner syndrome and a mild action and postural tremor. She was started on indomethacin sustained release, 75 mg daily. For a few days, she had two to three typical headaches occurring during the day while awake lasting 1 to 2 minutes, but less intense than previously and no nocturnal headaches. The headaches then completely resolved. She discontinued the indomethacin after about 1 month and has had no headaches for 6 weeks. Questions.— Is this case consistent with remitting chronic paroxysmal hemicrania or episodic paroxysmal hemicrania? Are they distinct entities or different names for the same disorder? If she was not able to tolerate indomethacin, are there any other medications which might be of benefit?