This accentuates the urgency for those diagnosed with CPH to receive an MRI head scan. Diagnosis
CPH is a long-term disease with symptoms lasting for longer than a year, either without remission or with remissions that last less than a month. In order to be diagnosed with CPH, a patient needs to have had at least 20 attacks filling the following criteria:
Attacks of severe unilateral orbital, supraorbital, or temporal pain lasting between 2 and 30 minutes. The headache needs to take place with one of the following:
Ipsilateral conjunctival injection and/or lacrimation
Ipsilateral nasal congestion and/or rhinorrhoea
Ipsilateral eyelid oedema
Ipsilateral forehead and facial sweating
Ipsilateral miosis and/or ptosis
Attacks need to occur more than five times a day for more than half of the time, although periods of lower frequency can occur. The symptoms cannot be attributed to another disorder. Attacks can be prevented completely by therapeutic doses of indomethacin.In addition, diagnosis of CPH requires that neuropathy of the supraorbital area in the temporal branch of the facial nerve be ruled out. Comparison to cluster headaches
Though outwardly similar to cluster headaches, chronic paroxysmal hemicrania is rather different, and the two headaches are not a subset of one or the other. Key differences include:

Different gender distributions – CPH is more common in women than men, with opposite occurring with cluster headaches. CPH attacks occur more frequently, but are shorter. CPH affects all over the headIndividuals with CPH are far more responsive to indomethacin than individuals with cluster headaches. CPH attacks can be provoked by neck movement.
Cluster headaches occur primarily in men, while CPH is more commonly diagnosed in women. The female to male ratio of diagnosed patients can range anywhere from 1.6:1 to 2.36:1. Symptoms may begin to appear at any age, but onset usually occurs in adulthood with a mean starting age within the thirties. History
CPH was discovered by Norwegians Ottar Sjaastad and Inge Dale in 1974. The term chronic paroxysmal hemicrania was first used in 1976 by Sjaastad to describe a condition seen in two of their patients who were experiencing repeated solitary and limited daily headache attacks on only one side of the cranium.It is possible that chronic paroxysmal hemicrania was first described by Johann Oppermann in 1747 under the term "hemicranias horologica". Oppermanns report included a 35-year-old woman who had hemicranial pain that lasted for 15 minutes and recurred regularly every hour.CPH has been included in the International Headache Societys classification system since 1988. See also
Hemicrania continua
Rebound headaches
Tension headaches
Trigeminal neuralgia

References


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