Paroxysmal Hemicrania Differential Diagnosis Table

Paroxysmal Hemicrania Differential Diagnosis Table:

Most people sometimes experience headaches on any side of the head due to different causes. However, paroxysmal hemicrania is a rare form of a one-sided headache affecting the area around the eye under the classification of Trigeminal Autonomic Cephalgias (TACs).
The condition is usually episodic, involving multiple, short-lasting attacks of sudden onset. The attacks can sometimes be severe and mostly diagnosed in women. The condition is associated with nasal congestion, swelling of the eyelid, reddening of the eye, and facial swelling.
The condition has two types; Episodic Paroxysmal Hemicrania and Chronic Paroxysmal Hemicrania. Episodic PH tends to occur at least twice a year with painless periods of about a month or longer and can last from about one week to one year. Chronic PH occurs over the course for more than a year without phases of no symptoms but can sometimes have phases of no symptoms lasting less than a month.

How To Distinguish Paroxysmal Hemicrania from Other Diseases

Distinguish Migraine from Paroxysmal Hemicrania – Diagnosis

A migraine is a neurological disease normally associated with sharp throbbing pain on one side of the head and can be triggered by certain factors like light.

• Paroxysmal hemicrania presentations are normally intermittent while presentations for migraines are usually on and off, that is, they come and go.
• Most of the time migraines involve throbbing pain and sensitivity to light while paroxysmal hemicrania does not have any sensitivity to light or autonomic symptoms like nasal congestion.

Several diagnostic procedures can be used to differentiate the two, e.g., patient history, monitoring headache characteristics, neurological examination, and some imaging to determine the cause.

Distinguish Tension Type Headache from Paroxysmal Hemicrania – Diagnosis

This is an any-sided type of headache which presents with a tight pressure band wrapped over the forehead. They are of 3 types; infrequent, frequent, and chronic.

• Tension-type headaches usually last for a few hours to days while paroxysmal hemicrania attacks are usually short and several times a day.
• Tension-type headaches usually affect any side of the head or can even affect the whole head while paroxysmal hemicrania attacks are usually unilateral.

No specific cause for tension-type headaches has been identified; however, it closely resembles migraines in different aspects.

Distinguish Cluster Headache from Paroxysmal Hemicrania – Diagnosis

These are headaches that occur in clusters, with each attack lasting for about 1-3 hours on average.

• Cluster headaches majorly occur in men while paroxysmal hemicrania majorly occurs in women.
• The duration of occurrence of cluster headaches is usually longer (1-3 hrs) compared to the duration in paroxysmal hemicrania, which is about 5-45 minutes.

Distinguish Cold Stimulus Headache from Paroxysmal Hemicrania – Diagnosis

Also known as ice-cream headache or brain freeze, headache is a form of pain triggered by the exposure of the unprotected head to a cold stimulus like beverages or materials that pass over the palate or the nasopharynx.

• In cold stimulus, the pain is mostly experienced in the forehead and might extend to the temporal parts while in paroxysmal hemicrania, the pain is usually unilateral.
• In cold stimulus, the cause or triggering factor is usually cold stimulus while in paroxysmal hemicrania, there’s still no definite cause identified.

Distinguish Trigeminal Neuralgia from Paroxysmal Hemicrania – Diagnosis

Also known as tic douloureux; is a typical pain experienced in the lower face and jaw and sometimes the area of the nose and eye, usually caused by irritation of the trigeminal nerve.

• Trigeminal neuralgia is usually characterized by an electric-like pain along the trigeminal nerve while paroxysmal hemicrania is a sharp throbbing pain on the unilateral side of the head.
• Trigeminal neuralgia does not present with autonomic symptoms while paroxysmal hemicrania typically presents with autonomic symptoms like nasal congestion.

Distinguish Cervicogenic Headache from Paroxysmal Hemicrania – Diagnosis

This is a chronic headache that usually arises from the atlanto-occipital and upper cervical joints and is perceived in one or more regions of the head or face.

• In cervicogenic headaches, the pain arises from the neck region while in paroxysmal hemicrania, the pain is majorly on the unilateral side of the head.

Distinguish Hemicrania Continua from Paroxysmal Hemicrania – Diagnosis

Hemicrania continua is described by continuous and fluctuating pain usually on one side of the head.

• In hemicrania continua, the headache is continuous and constant while paroxysmal hemicrania headaches are short and frequent.
• In hemicrania continua, the pain on the side of the head can switch sides depending on exacerbations while in paroxysmal hemicrania, the pain is centered on one side.

Distinguish SUNCT Syndrome from Paroxysmal Hemicrania – Diagnosis

Also known as short-lasting, unilateral, neuralgiform attacks with conjunctival injection and tearing, is a form of headache disorder associated with unilateral trigeminal pain.

• In SUNCT syndrome, the pain attacks are usually very brief and severe, lasting for a few seconds while in paroxysmal hemicrania, the attacks are short but more prolonged.

Distinguish Hypnic Headache Syndrome from Paroxysmal Hemicrania – Diagnosis

Also known as an alarm clock headache, it is a rare headache that usually starts during sleep and can wake a person up. Pain lasts for about 15 minutes.

• The distinguishing factor arises from timing where hypnic headache syndrome occurs during sleep and wakes somebody lasting for about 15 minutes while paroxysmal hemicrania starts at wakefulness.

Important Red Flags with Paroxysmal Hemicrania

The disease presents with a lot of signs that have the same presentations as other diseases, of which if not thoroughly diagnosed, one might end up with a wrong diagnosis.
Some of the key factors to be checked are the onset, the duration, whether or not it presents with autonomic symptoms, the response to different medications, and the triggering factors.