Sjaastad Ottar
Department of Neurology, Trondheim, Norway.
Curr Pain Headache Rep. 2006 Aug;10(4):295-301. doi: 10.1007/s11916-006-0035-x.
The first patient with chronic paroxysmal hemicrania (CPH), a 41-year-old woman, first seen in 1961, was followed until an adequate treatment was found, 12 years later. Clinically, attack frequency and duration differed widely from the general pattern of cluster headache. Ocular variables, such as intraocular pressure and corneal indentation pulse amplitudes, also differed in our case (clear symptomatic side increment during attacks) and cluster headache. Pupil reactions to directly and indirectly acting sympathicomimetic drugs were also vastly different in our case and cluster headache: no signs of Horner s syndrome in our patient, while cluster headache exhibits a "Horner-like pattern." In cluster headache, there is a relative hypohidrosis in the forehead on the symptomatic side if body temperature is increased, and a clear hyperhidrosis on direct parasympathomimetic stimulation. This was not so in our case. Indomethacin was highly effective in our case, while "cluster headache drugs," such as ergotamine/sumatriptan, were ineffective. Indomethacin was inactive in cluster headache. Accordingly, our case seemed to differ decisively from cluster headache: CPH had been discovered.
首例慢性阵发性偏侧头痛（CPH）患者为一名41岁女性，于1961年首次就诊，随访至12年后找到充分的治疗方法。临床上，发作频率和持续时间与丛集性头痛的一般模式有很大差异。眼部变量，如眼压和角膜压痕脉搏幅度，在我们的病例（发作期间症状侧明显增加）和丛集性头痛中也有所不同。在我们的病例和丛集性头痛中，瞳孔对直接和间接作用的拟交感神经药物的反应也有很大差异：我们的患者没有霍纳综合征的迹象，而丛集性头痛表现出“类霍纳模式”。在丛集性头痛中，如果体温升高，症状侧前额会出现相对少汗，直接拟副交感神经刺激时会出现明显多汗。我们的病例并非如此。吲哚美辛在我们的病例中非常有效，而“丛集性头痛药物”，如麦角胺/舒马曲坦，则无效。吲哚美辛在丛集性头痛中无活性。因此，我们的病例似乎与丛集性头痛有决定性差异：慢性阵发性偏侧头痛被发现了。
