Chronic paroxysmal hemicrania Chronic paroxysmal hemicrania Chronic paroxysmal hemicrania (CPH), also known as Sjaastad syndrome, is a severe debilitating unilateral headache usually affecting the area around the eye. It normally consists of multiple severe, yet short, headache attacks affecting only one side of the cranium. It is more commonly diagnosed in women than in men, but, unlike a migraine, has no neurological symptoms associated with it. CPH headaches are treated through the use of non-steroidal anti-inflammatory drugs, with indomethacin found to be usually effective in eliminating symptoms. Paroxysmal hemicrania is classified by the frequency and duration of attacks experienced by patients. Episodic paroxysmal
Hemicrania continua topiramate 100–200 mg per day (Topamax) although side effects with this treatment can also prove problematic. Greater occipital nerve (GON) block comprising 40 mg Depomedrone and 10 mls of 1% Lignocaine injected into the affected nerve is effective, up to a period of approximately three months. Changing the 'cocktail' to include (for example) 10 mls of .5% Marcaine and changing to 2% Lignocaine, whilst in theory should increase the longevity, renders the injection completely ineffective. See 4.2 Posology and method of administration (flocculation). Occipital nerve stimulation may be highly effective when other treatments fail to relieve the intractable pain. Hemicrania