Paroxysmal hemicrania is also known as Sjaastad syndrome.
It is most common among adult women and attacks last an average of 15 minutes. Some headaches are self-limiting, of variable duration and chronic.
Trigger factors may be: twisting of the neck, chewing, laughter, Valsalva manoeuvre, eye pressure, etc. The spectacular response to indomethacin is the diagnosis.
There are certain consensuated criteria for the diagnosis: At least 50 attacks, attacks of severe unilateral orbital, supraorbital and/or temporal pain, always on the same side, of 2 to 45 minutes duration. It’s accompanied by conjunctival injection or tearing or nasal congestion, rhinorrhea, ptosis or palpebral oedema. To an absolute effectiveness of indomethacin, a dose of 150 mg/day or less.
When pharmacological treatment is not sufficient, the options surgical are:
RADIOFREQUENCY OF THE PTERYGOPALATINE GANGLION
This is a simple technique performed under local anaesthesia and minimum sedation, with ablation of the pterygopalatine ganglion, the ganglion involved in cluster headache.
The patient is discharged 2 hours after completing the procedure. Complications are very infrequent, and only mild.
The probability of improvement with this technique is 60%.
OCCIPITAL NERVE STIMULATION
This technique is somewhat more complex than radiofrequency of the pterygopalatine ganglion. It is usually indicated when radiofrequency of the pterygopalatine ganglion has not been sufficient to reduce the pain. It is extracranial surgery, and so there are no severe complications. The probability of improvement for this headache is 70%.
