Bilateral Paroxysmal Hemicrania with Autonomic Symptoms: The First Case Report

Paroxysmal hemicrania (PH) is a rare headachedisorder of unknown aetiology with a mean age ofonset of 34 years, with a range of 6–81 years. Thepain is always unilateral, often severe, with a dura-tion between 2 and 30 min (occasionally 2 h), and afrequency of attacks of 2–30 per 24 h with an evencircadian distribution (1). Ipsilateral autonomicsymptoms occur during attacks with the followingfrequencies: lacrimation, 62%; conjunctival injec-tion, 36%; nasal congestion, 42%; and rhinorrhea,36% (2). Eyelid oedema, ptosis, miosis and facialsweating are less frequently reported. There is afemale to male predominance of about 2.36 : 1. Sideshift has been rarely reported (3). There are twoforms: the episodic, which occurs during a periodlasting 7 days to 1 years separated by pain-freeperiods lasting 1 month or more; and the chronic,which has attacks that occur for more than 1 yearwithout remission or with remissions lasting lessthan 1 month.To my knowledge, this is the first case report ofbilateral PH with cranial autonomic symptoms.