What are the paroxysmal hemicranias?
The paroxysmal hemicranias (PHs) are a group of rare, benign headache disorders that resemble cluster headache in most ways but are less responsive to medications typically effective for cluster headache. The PHs are characterized by severe, excruciating, throbbing, boring, or pulsatile pain affecting the orbital, supraorbital, and temporal regions. These pains are associated with at least one of the following signs or symptoms ipsilateral to the painful side:
- • Conjunctival injection
- • Lacrimation
- • Nasal congestion
- • Rhinorrhea
- • Ptosis
- • Eyelid edema
Attacks occur from 1 to 40 times daily, usually exceeding eight attacks in a 24-hour period. Duration is typically 2 to 30 minutes, but on rare occasions attacks last as long as 2 hours. Headaches may occur any time during the day or night, and there is often a predisposition to nocturnal attacks, in which the patient is awakened from a sound sleep by an incapacitating headache.