What is the focus of the physical exam for suspected chronic paroxysmal hemicrania (CPH)?

Updated: Jun 12, 2019
  • Author: Monica Saini, MD, MBBS; more...
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Answer

Patients with CPH who have had dissociation in pain and autonomic features also have been described. Other points to consider in the physical examination include the following:

  • No definite evidence points to a Hornerlike syndrome, such as that described in cluster headache (CH), but mild miosis and eyelid edema that may mimic ptosis may be observed

  • Forehead sweating may increase on the ipsilateral side, and patients with generalized sweating have been reported

  • The coexistence of CPH and trigeminal neuralgia is called CPH-tic syndrome; many cases of this syndrome have been reported

  • Simultaneous occurrence of ipsilateral CH and migraine headache in patients with CPH has been reported

  • PH has been reported to co-occur with primary cough and stabbing headache, which are also indomethacin-sensitive [18]

  • Perform a careful physical examination to evaluate pathologic secondary headache


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