Paroxysmal Hemicrania – Location, Causes and Treatment

Paroxysmal Hemicrania is a rare headache disorder that belongs to the TACs (Trigeminal Autonomic Neuralgia) group of disorders and includes sudden onset of debilitating headache on one side of the head that is short in duration but re-occurs, in some cases, several times a day.

Location of pain

Headache is experienced on one side of the head, behind the eyes, in forehead, temples and occasionally reaching to the back of the neck.

Duration of pain

On average, an attack lasts around 15 minutes but the rate of recurrence is 15-20 attacks experienced per day. Paroxysmal Hemicrania is characterized by bouts of pain that last from one week to one year with pain-free periods of sometimes more than 3 months.


  • Redness of eyes
  • Nasal congestion
  • Photophobia and Phonophobia
  • Facial flushing
  • Nausea and Vomiting
  • Unilateral pain in the head
  • Headache is throbbing in character
  • Resembles a cluster headache
  • Neurological symptoms on the opposite side of the body
  • Pain is triggered by movement
  • Responsive to indomethacin


There is no known cause of Paroxysmal Hemicrania but according to some case studies, here are a list of possible causes

  • Traumatic injury to your neck or head
  • Arteriovenous malformation
  • Pituitary gland tumor

Some of the triggers of Paroxysmal Hemicrania are

  • Foods like cheese, chocolate, coffee, and alcohol.
  • Changes in temperature
  • Exercise
  • A certain head position that can lead to headache such as in orthostatic headache
  • Stress

Risk factors

  • The onset of this condition is mostly in later years, on average 40 years is mean age of onset.
  • Females are more prone to get this headache.

Paroxysmal Hemicrania and Cluster Headache

Like Cluster Headache, it is episodic in character and is characterized by severe debilitating pain. But clusters are predominant in males, unlike Hemicranias which are more common in females and have a very good response towards Indomethacin other as compared to any other drug from its class.


If a person does not show compliance with medication the doctor might ask him to get brain imaging done. An MRI would show the pituitary gland and posterior cranial fossa in a focused view.

An important point in diagnosis is, complete relief in response to indomethacin, an NSAID, this confirms Paroxysmal Hemicrania


  • After proper diagnosis, the cause is treated.
  • Paroxysmal Hemicrania responds very well to indomethacin, an NSAID.
  • Identify your triggers and try to avoid them.
  • Most people reported with complete relief without any sort of treatment.

When to consult the doctor?

If the headache due to Paroxysmal Hemicrania is increasing in intensity, severity or frequency and you start having other associated symptoms such as fever and neck stiffness you should consult the doctor as early as possible.


When should I be worried about recurrent Paroxysmal Hemicrania?

When you start having other associated symptoms such as fever and neck stiffness you should book your appointment.

What other headache does the Paroxysmal Hemicrania resemble?

In terms of character, it resembles Migraines but according to its period of recurrence, it resembles a cluster headache.

What is TAC?

TAC is Trigeminal Autonomic Cephalgias, it is a group of disorders that includes trigeminal pain with some autonomic signs.