How is chronic paroxysmal hemicrania (CPH) differentiated from cluster headache (CH)?

Updated: Jun 12, 2019
  • Author: Monica Saini, MD, MBBS; more...
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The trigeminal-autonomic cephalgias include cluster headache (CH) and paroxysmal hemicranias in which head pain and cranial autonomic symptoms are prominent. CH is the most important differential diagnosis.

CH has male preponderance, unlike CPH. In CPH, the frequency of attacks is higher, usually more than 15 in 24 hours, whereas CH has an attack frequency of 1–4 (maximum 8) in 24 hours. The duration of headaches is shorter in CPH (2–25 min) than in CH (15–60 min). While CH has a nocturnal preponderance, CPH does not demonstrate any circadian rhythm. Autonomic symptoms tend to be more severe in CH. Finally, CPH can be distinguished by its response to indomethacin therapy, which is not seen in CH.

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