Simultaneous Occurrence of Ipsilateral Cluster Headache and Chronic Paroxysmal Hemicrania: A Case Report

Abstract

A 42-year-old man came to our headache unit in October 1995 complaining of recurrent attacks of headache, which had begun in February 1991. Chronic cluster headache was diagnosed, and he was given verapamil, 360 mg per day. The attacks ceased in the following months and verapamil was stopped in March 1996. In May 1997, a recurrence of the attacks required the readministration of verapamil, 360 mg per day. The attacks decreased (one to three per week), but after 2 months the patient reported a worsening in his condition due to the appearance of shorter attacks, which were diagnosed as chronic paroxysmal hemicrania. The administration of indomethacin, 225 mg per day, resulted in the disappearance of the short attacks.The concomitant occurrence of attacks of cluster headache and chronic paroxysmal hemicrania suggests the presence of shared factors in the pathophysiology of the two forms of headache. This hypothesis is supported by previous reports in the literature. Key words: chronic cluster headache, chronic paroxysmal hemicrania, verapamil, indomethacinAbbreviations: CH cluster headache, CPH chronic paroxysmal hemicrania ( Headache 2000;40:54-56) The coexistence of cluster headache (CH) and chronic paroxysmal hemicrania (CPH) in the same patient has been previously reported in four published cases. 1-3 The two varieties of headache occurred in different periods in three of the four patients, whereas their simultaneous occurrence was reported in one patient. Here, we report the case of a patient with concomitant attacks of CH and ipsilateral CPH in the same period. Our experience adds data to support the likelihood of the concomitant presence of attacks of CH and ipsilateral CPH. CASE REPORTA 42-year-old policeman, who was married with three children, came to our Headache Unit in October 1995 complaining of recurrent attacks of headache. These attacks had started suddenly and without any particular reason for the first time in February 1991, when he was 37 years old. He had two to three attacks per day, each lasting 30 minutes to 2 hours; the timetable was unpredictable, although the most critical times were after lunch and during the night. The pain was extremely severe and located around the left temple, eye, and forehead, without radiation. The pain was throbbing and was associated with ipsilateral lacrimation and conjunctival injection, ptosis, rhinorrhea, photophobia, and phonophobia. The patient did not report a family history of headache. He smoked 20 cigarettes per day and drank four to five cups of coffee per day, but no alcoholic beverages. He weighed 87 kg and was 188 cm in height.The results of routine blood tests, an EEG, skull x-ray, and a cranial CT scan were normal. Nonsteroidal anti-inflammatory drugs, decreasing dosages of cortisone, lithium salts, and amitriptyline gave almost no benefit, whereas since 1994 he had been responsive to sumatriptan, 6 mg subcutaneous (SQ), for the treatment of the attacks.

Coexistence of cluster headache and paroxysmal hemicrania: does it exist? A case report and literature review

“…for PHOnly 1 episode of PH (no recurrence after withdrawal of indo) a Case 245 Y/Mf:2–3/dayd: 120 mtsf:15–30/dayd: 2–30 mtsPast history of CHRecent attacks include both PH and CHVerapamil for CHIndo. for PHOnly 1 episode of PH (no recurrence after withdrawal of indo) a Centonze et al [4]42 Y/Mf:2–3/dayd: 30–120 mtsf:8–16/dayd: 5–12 mtsPast history of CHRecent attacks include both PH and CHVerapamil for CHIndo. for PHOnly 1 episode of PH (no recurrence after withdrawal of indo) a Gobel et al b [5]47/M b b b b b

a At least two attacks separated by pain-free remission periods of ≥1 month are required for IHS criteria of EPH

b Details not available

com complete, d duration, f frequency, Indo Indomethacin, mts minutes, Y years

…”

“…Another case of simultaneous occurrence of CH and PH was described by Centonze [4] in a 42-year-old male. The patient with the history of ECH for about 6 years developed PH-like attacks (short duration and higher frequency) in a fresh episode of CH.…”

Effective management of ice pick pains, SUNCT, and episodic and chronic paroxysmal hemicrania

“…Disorders that have mimicked the paroxysmal hemicranias have included circle of Willis aneurysms [81], arteriovenous malformations and cerebrovascular accidents [66,82], collagen vascular disease [81], Pancoast tumor [83], tumors of the frontal lobe [81], sella turcica [84,85] and cavernous sinus [86], intracranial hypertension [87], and thrombocythemia [88]. CPH has been reported to occur in association with migraine [89], cluster headache [90][91][92][93], and trigeminal neuralgia [94][95][96].…”

Coexisting Trigeminal Autonomic Cephalalgias and Hemicrania Continua

“…The authors categorically mentioned the coexistence of CH and PH in 3 patients in the literature. However, in the literature we noted at least 2 more cases 8,9 . In the same way, the authors failed to review a case presenting with both CH and HC 10 .…”