Which clinical history findings are characteristic of chronic paroxysmal hemicrania (CPH)?

Updated: Jun 12, 2019
  • Author: Monica Saini, MD, MBBS; more...
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The pain in chronic paroxysmal hemicrania (CPH) is characteristically unilateral. However, pain may switch sides between attacks and can rarely be bilateral. [16]

Patients usually report pain that is severe in intensity and has an abrupt onset and cessation. During severe attacks, excruciating pain that is throbbing, boring, pulsating, or clawlike in character has been described. The location of pain is primarily in the distribution of the ophthalmic division of the trigeminal nerve and C2, followed by the maxillary-mandibular and C3 distributions. Accompanying photophobia and phonophobia has been reported, usually lateralizing to the side of the pain. Occasionally, patients may experience nausea, though vomiting is rare. In 50%–80% of patients, agitation or restlessness may be noted. [10, 17]

Headache can develop at any time in patients with CPH, in contrast to CH, in which the headache usually occurs at night.

The attack frequency usually is 10–20 attacks daily, but it may range from 2 to 40 attacks daily. Attacks usually last 2–25 minutes, but they may last as long as 60 minutes. In a prospective study, mean attack duration was 13 minutes (range 3–46 min). In a retrospective study, the mean duration of attacks was 21 minutes (range 2–120 min).

CPH has been reported to be triggered by various stimuli, including neck movement, external pressure to the neck, or other factors.

CPH attacks are accompanied by autonomic symptoms, mostly on the same side as the pain, such as red eyes, tearing, nasal congestion, and, sometimes, rhinorrhea. Occasionally, photophobia may be present. Gastrointestinal symptoms are very rare.

Recognizing the various stages and different patterns of CPH is important. For example, during severe, frequent attacks, patients may describe a constant headache or persisting tenderness on the symptomatic side.

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