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Paroxysmal Hemicrania — SCE Neurology MCQ

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HardHeadache & Facial PainParoxysmal HemicraniaSCE Neurology

A patient has eight to twelve strictly unilateral orbital headaches daily, each lasting 10–25 minutes with tearing and nasal congestion. MRI is normal and an adequate indomethacin trial abolishes attacks completely. What is the diagnosis?

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Correct answer: AParoxysmal hemicrania

The best answer is “Paroxysmal hemicrania”. Paroxysmal hemicrania consists of frequent short trigeminal-autonomic attacks lasting 2–30 minutes and is defined by an absolute indomethacin response. “Cluster headache” is less appropriate because cluster attacks are usually longer and are not defined by indomethacin responsiveness “SUNCT” is less appropriate because SUNCT attacks are generally seconds to a few minutes and prominently feature conjunctival injection and tearing “Trigeminal neuralgia” is less appropriate because trigeminal neuralgia has triggerable shock-like facial pain rather than sustained orbital autonomic attacks “Hemicrania continua” is less appropriate because hemicrania continua has continuous background unilateral pain between exacerbations

Reference: NICE CG150: Headaches in over 12s — recommendations. https://www.nice.org.uk/guidance/cg150/chapter/recommendations