Chronic paroxysmal hemicrania

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A. At least 30 attacks fulfilling criteria B-E.

B. Attacks of severe unilateral orbital, supraorbital, and/or temporal pain always on the same side, lasting 2-45 minutes.

C. Attack frequency greater than five a day for more than half the time and tearing (periods with lower frequency may occur).

D. Pain is associated with at least one of the following signs/symptoms on the pain side:

1. Conjunctival injection.

2. Lacrimation.

3. Nasal congestion.

4. Rhinorrhea.

5. Ptosis.

6. Eyelid edema.

E. At least one of the following:

1. There is no suggestion of one of the disorders such as trigeminal neuralgia, idiopathic stabbing headache, cough headache, benign exertional headache, headache associated with sexual activity, or hypnic headache.

2. Such a disorder is suggested but excluded by appropriate investigations.

3. Such a disorder is present, but the first headache attacks do not occur in close temporal relation to the disorder.

Note: Most cases respond rapidly and absolutely to indomethacin (usually in doses of 150 mg/day or less) Episodic paroxysmal hemicrania

A. At least 30 attacks fulfilling criteria B-F.

B. Attacks of severe unilateral orbital or temporal pain, or both, that is always unilateral and lasts from 1 to 30 minutes.

C. An attack frequency of three or more a day.

D. Clear intervals between bouts of attacks that may last months to years.

E. Pain is associated with at least one of the following signs or symptoms on the painful side:

1. Conjunctival injection.

2. Lacrimation.

3. Nasal congestion.

4. Rhinorrhea.

5. Ptosis.

6. Eyelid edema.

F. At least one of the following:

1. There is no suggestion of one of the disorders such as trigeminal neuralgia, idiopathic stabbing headache, cough headache, benign exertional headache, headache associated with sexual activity, or hypnic headache.

2. Such a disorder is suggested but excluded by investigations..

3. Such a disorder is present, but the first headache attacks do not occur in close temporal relation to the disorder.

Note: In most cases responds rapidly and absolutely to indomethacin (usually 150 mg/day or less).

Adapted with permission from Goadsby PJ, Lipton RB. A review of paroxysmal hemicranias SUNCT syndrome and other short-lasting headache with autonomic features, including new cases. Brain 1997;120:193-209.

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