Paroxysmal Hemicrania (PH) vs. Cluster Headache (CH)

Both are primary headache disorders, but they differ in key features. Here’s a concise comparison:

Feature	Paroxysmal Hemicrania	Cluster Headache
Pain Location	Strictly unilateral, often orbitotemporal	Strictly unilateral, often orbitotemporal
Pain Duration	2–30 minutes (shorter)	15–180 minutes (longer)
Attack Frequency	5–40 attacks/day (more frequent)	1–8 attacks/day (less frequent)
Gender Predominance	Slightly more common in women (2:1)	More common in men (3:1)
Autonomic Symptoms	Yes (e.g., tearing, nasal congestion, eyelid edema)	Yes (prominent, e.g., tearing, nasal congestion)
Restlessness/Agitation	Less common	Common (90% of cases)
Response to Indomethacin	Absolute (diagnostic; relieves symptoms)	Minimal to none
Triggers	Less commonly triggered by alcohol	Often triggered by alcohol, nitroglycerin
Chronic vs. Episodic	Chronic more common; episodic rare	Episodic more common; chronic less common

Key Diagnostic Notes:

• Paroxysmal Hemicrania: Defined by its complete response to indomethacin (25–300 mg/day). Attacks are shorter and more frequent. Classified as a trigeminal autonomic cephalalgia (TAC).
• Cluster Headache: Longer attacks, less frequent, with prominent restlessness. Triptans (e.g., sumatriptan) or oxygen are effective acute treatments, not indomethacin.

Diagnosis:

• PH requires an indomethacin trial to confirm diagnosis (per ICHD-3 criteria).
• CH diagnosis is clinical, based on attack characteristics and autonomic features.

Treatment:

• PH: Indomethacin is first-line; alternatives (e.g., COX-2 inhibitors) if intolerant.
• CH: Acute (oxygen, triptans); preventive (verapamil, corticosteroids).

If differentiating clinically, an indomethacin trial is critical. Always consult a neurologist for atypical cases or overlap symptoms.

Sources: ICHD-3 criteria, clinical neurology texts (e.g., Bradley’s Neurology).

Disclaimer: owerl is not a doctor; please consult one.