Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Paroxysmal hemicrania: Treatment and prognosis

Manjit S Matharu, MD
Anna S Cohen, MD
Section Editor
Jerry W Swanson, MD, MHPE
Deputy Editor
John F Dashe, MD, PhD


The trigeminal autonomic cephalalgias (TACs) are a group of primary headache disorders characterized by unilateral trigeminal distribution pain that occurs in association with ipsilateral cranial autonomic features [1,2]. The TACs include cluster headache, paroxysmal hemicrania, short-lasting unilateral neuralgiform headache attacks, and hemicrania continua [3].

Despite their common elements, the TACs differ in attack duration and frequency, as well as the response to therapy (table 1).

Hemicrania continua is characterized by continuous pain with exacerbations

Cluster headache has a relatively long attack duration and relatively low attack frequency

Paroxysmal hemicrania has intermediate attack duration and frequency

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Nov 02, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Goadsby PJ, Lipton RB. A review of paroxysmal hemicranias, SUNCT syndrome and other short-lasting headaches with autonomic feature, including new cases. Brain 1997; 120 ( Pt 1):193.
  2. Goadsby PJ. Trigeminal autonomic cephalalgias. Pathophysiology and classification. Rev Neurol (Paris) 2005; 161:692.
  3. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 2013; 33:629.
  4. Boes CJ, Dodick DW. Refining the clinical spectrum of chronic paroxysmal hemicrania: a review of 74 patients. Headache 2002; 42:699.
  5. Sjaastad O, Apfelbaum R, Caskey W, et al. Chronic paroxysmal hemicrania (CPH). The clinical manifestations. A review. Ups J Med Sci Suppl 1980; 31:27.
  6. Matharu MS, Cohen AS, Frackowiak RS, Goadsby PJ. Posterior hypothalamic activation in paroxysmal hemicrania. Ann Neurol 2006; 59:535.
  7. Cittadini E, Matharu MS, Goadsby PJ. Paroxysmal hemicrania: a prospective clinical study of 31 cases. Brain 2008; 131:1142.
  8. Fuad F, Jones NS. Paroxysmal hemicrania and cluster headache: two discrete entities or is there an overlap? Clin Otolaryngol Allied Sci 2002; 27:472.
  9. Lambru G, Matharu M. Management of trigeminal autonomic cephalalgias in children and adolescents. Curr Pain Headache Rep 2013; 17:323.
  10. Sjaastad, O. Chronic paroxysmal hemicrania. In: Handbook of Clinical Neurology, Vol.48, Vinken, PJ, Bruyn, GW, Klawans, HL, Rose, FC (Eds). Elsevier Science, Amsterdam 1986. p.257.
  11. Sjaastad O, Stovner LJ, Stolt-Nielsen A, et al. CPH and hemicrania continua: requirements of high indomethacin dosages--an ominous sign? Headache 1995; 35:363.
  12. Pareja JA, Caminero AB, Franco E, et al. Dose, efficacy and tolerability of long-term indomethacin treatment of chronic paroxysmal hemicrania and hemicrania continua. Cephalalgia 2001; 21:906.
  13. Antonaci F, Sjaastad O. Chronic paroxysmal hemicrania (CPH): a review of the clinical manifestations. Headache 1989; 29:648.
  14. Kudrow DB, Kudrow L. Successful aspirin prophylaxis in a child with chronic paroxysmal hemicrania. Headache 1989; 29:280.
  15. Evers S, Husstedt IW. Alternatives in drug treatment of chronic paroxysmal hemicrania. Headache 1996; 36:429.
  16. Mateo I, Pascual J. Coexistence of chronic paroxysmal hemicrania and benign cough headache. Headache 1999; 39:437.
  17. Hannerz J, Ericson K, Bergstrand G. Chronic paroxysmal hemicrania: orbital phlebography and steroid treatment. A case report. Cephalalgia 1987; 7:189.
  18. Durko, A, Klimek, A. Naproxen in the treatment of chronic paroxysmal hemicrania. Cephalalgia 1987; 7:361.
  19. Pradalier A, Dry J. [Chronic paroxysmal hemicrania. Treatment with indomethacin and diclofenac]. Therapie 1984; 39:185.
  20. Sjaastad O, Antonaci F. A piroxicam derivative partly effective in chronic paroxysmal hemicrania and hemicrania continua. Headache 1995; 35:549.
  21. Siow HC. Seasonal episodic paroxysmal hemicrania responding to cyclooxygenase-2 inhibitors. Cephalalgia 2004; 24:414.
  22. Chakravarty A, Mukherjee A, Roy D. Trigeminal autonomic cephalgias and variants: clinical profile in Indian patients. Cephalalgia 2004; 24:859.
  23. Lisotto C, Maggioni F, Mainardi F, Zanchin G. Rofecoxib for the treatment of chronic paroxysmal hemicrania. Cephalalgia 2003; 23:318.
  24. Mathew NT, Kailasam J, Fischer A. Responsiveness to celecoxib in chronic paroxysmal hemicrania. Neurology 2000; 55:316.
  25. Zidverc-Trajkovic J, Pavlovic AM, Mijajlovic M, et al. Cluster headache and paroxysmal hemicrania: differential diagnosis. Cephalalgia 2005; 25:244.
  26. de Almeida DB, Cunali PA, Santos HL, et al. Chronic paroxysmal hemicrania in early childhood: case report. Cephalalgia 2004; 24:608.
  27. Schlake HP, Böttger IG, Grotemeyer KH, et al. Single photon emission computed tomography (SPECT) with 99mTc-HMPAO (hexamethyl propylenamino oxime) in chronic paroxysmal hemicrania--a case report. Cephalalgia 1990; 10:311.
  28. Shabbir N, McAbee G. Adolescent chronic paroxysmal hemicrania responsive to verapamil monotherapy. Headache 1994; 34:209.
  29. May A, Leone M, Afra J, et al. EFNS guidelines on the treatment of cluster headache and other trigeminal-autonomic cephalalgias. Eur J Neurol 2006; 13:1066.
  30. Coria F, Claveria LE, Jimenez-Jimenez FJ, de Seijas EV. Episodic paroxysmal hemicrania responsive to calcium channel blockers. J Neurol Neurosurg Psychiatry 1992; 55:166.
  31. Warner JS, Wamil AW, McLean MJ. Acetazolamide for the treatment of chronic paroxysmal hemicrania. Headache 1994; 34:597.
  32. Pascual J, Quijano J. A case of chronic paroxysmal hemicrania responding to subcutaneous sumatriptan. J Neurol Neurosurg Psychiatry 1998; 65:407.
  33. Hannerz J, Jogestrand T. Intracranial hypertension and sumatriptan efficacy in a case of chronic paroxysmal hemicrania which became bilateral. (The mechanism of indomethacin in CPH). Headache 1993; 33:320.
  34. Antonaci F, Pareja JA, Caminero AB, Sjaastad O. Chronic paroxysmal hemicrania and hemicrania continua: anaesthetic blockades of pericranial nerves. Funct Neurol 1997; 12:11.
  35. Rossi P, Di Lorenzo G, Faroni J, Sauli E. Seasonal, extratrigeminal, episodic paroxysmal hemicrania successfully treated with single suboccipital steroid injections. Eur J Neurol 2005; 12:903.
  36. Albertyn J, Barry R, Odendaal CL. Cluster headache and the sympathetic nerve. Headache 2004; 44:183.
  37. Miller S, Lagrata S, Watkins L, Matharu M. Occipital Nerve Stimulation for Medically Refractory Chronic Paroxysmal Hemicrania. Headache 2017; 57:1610.
  38. Tso AR, Marin J, Goadsby PJ. Noninvasive Vagus Nerve Stimulation for Treatment of Indomethacin-Sensitive Headaches. JAMA Neurol 2017; 74:1266.
  39. Walcott BP, Bamber NI, Anderson DE. Successful treatment of chronic paroxysmal hemicrania with posterior hypothalamic stimulation: technical case report. Neurosurgery 2009; 65:E997; discussion E997.