How is chronic paroxysmal hemicrania (CPH) treated?

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

The treatment of choice for chronic paroxysmal hemicrania (CPH) is indomethacin, which has an absolute effect on the symptoms. Episodic cluster headache (CH) and CPH respond well to this agent. Take precautions to prevent serious gastrointestinal and renal complications secondary to long-term use of indomethacin. Indomethacin should be administered in three or more doses per day because of its short half-life time of 4 hours. [3]

Approximately 30% of patients report dose-limiting side effects with indomethacin and about 20% may discontinue indomethacin due to side effects. The evidence for other medications is available from only open studies. [23] The best evidence amongst these medications is for verapamil. Other medications with reported benefits include acetazolamide, topiramate, piroxicam, and aspirin. [24]


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