What is paroxysmal hemicrania?
Paroxysmal hemicrania is a rare headache disorder that causes sudden, intense headaches on one side of the face. Patients with paroxysmal hemicrania may also experience eye redness, eye tearing, nasal congestion, and facial flushing on the same side of the face where the pain occurs.
If you are experiencing these symptoms, it’s important to get a thorough medical evaluation and an accurate diagnosis. Your provider will be able to rule out other primary headache disorders that mimic paroxysmal hemicrania symptoms and distinguish it from conditions like cluster headache, trigeminal neuralgia, and primary stabbing headache. As a leading neurology provider in the southeastern Pennsylvania and New Jersey area, Penn Medicine can pinpoint a diagnosis for you and create a treatment plan to help you get back to living your life pain-free.
Types of paroxysmal hemicrania
There are two types of paroxysmal hemicrania, each with different characteristics. While you may initially experience one type, it’s possible to transition between types over time.
- Chronic paroxysmal hemicrania: These constant headache attacks last for at least a year without significant pain-free periods between episodes.
- Episodic paroxysmal hemicrania: These less frequent attacks occur at least twice a year with periods of remission lasting at least three months between episodes.
Symptoms of paroxysmal hemicrania
Paroxysmal hemicrania causes severe pain on one side of the face. Patients describe the pain as sharp, throbbing, or burning, typically centered around or behind the eye or in the temple area. These intense episodes of pain, occurring five to 40 times per day and lasting two to 30 minutes each, can significantly disrupt normal activities.
In addition to the headache pain, paroxysmal hemicrania symptoms may include:
- Agitation
- Ear fullness
- Eyelid swelling or drooping
- Facial flushing
- Nasal congestion
- Red and tearing eyes
- Sensitivity to light
- Sweating
What causes paroxysmal hemicrania?
The exact cause of paroxysmal hemicrania is unknown. However, researchers have learned the condition typically appears during adulthood, is more common in people assigned female at birth, and may involve the trigeminal nerve responsible for facial sensation. Patients with paroxysmal hemicrania have reported various triggers, including alcohol consumption, exercise, specific head or neck movements, and stress. Researchers are studying the role genetics might play in the development of the condition.
How paroxysmal hemicrania is diagnosed
Diagnosing paroxysmal hemicrania involves an evaluation by a healthcare provider that specializes in diagnosing and treating headaches. Since there isn’t a specific test for this condition, the diagnosis relies on a thorough review of your medical history and symptoms, and a physical exam. Be prepared to talk with your doctor about the frequency, severity, duration, and location of your headaches. A magnetic resonance imaging (MRI) scan may be required to rule out other conditions that mimic paroxysmal hemicrania symptoms.
Paroxysmal hemicrania treatment options
Paroxysmal hemicrania is typically treated with a prescription nonsteroidal anti-inflammatory drug (NSAID). Patients take this medication daily to prevent attacks. Alternative medications or nerve block procedures may also be prescribed. A headache specialist will monitor you closely and adjust the dosage based on the frequency and severity of your attacks. Penn Medicine has a dedicated team of neurologists who specialize in treating various headache disorders, including paroxysmal hemicrania, and will work with you to find a treatment that can improve your quality of life.