INTRACRANIAL HYPERTENSION AND SUMATRIPTAN EFFICACY IN A CASE OF CHRONIC PAROXYSMAL HEMICRANIA WHICH BECAME BILATERAL - (THE MECHANISM OF INDOMETHACIN IN CPH)
J. Hannerz et T. Jogestrand, INTRACRANIAL HYPERTENSION AND SUMATRIPTAN EFFICACY IN A CASE OF CHRONIC PAROXYSMAL HEMICRANIA WHICH BECAME BILATERAL - (THE MECHANISM OF INDOMETHACIN IN CPH), Headache, 33(6), 1993, pp. 320-323
A female patient is described who had a four year long period of unila
teral chronic paroxysmal hemicrania (CPH) which then became bilateral.
For some years before the CPH started she suffered from periods of ab
out one month with chronic hemicrania without nerve involvement. She a
lso suffered from chronic fatigue, back pain, arthralgia, vertigo, chr
onic constipation and spontaneous ecchymoses. Blood tests showed chron
ic leukocytosis, low serum iron, and signs of inflammation in serum el
ectrophoresis during the five years she was studied. CPH attacks could
be provoked by breathing 6% carbon dioxide in air. Lumbar cerebrospin
al fluid pressure was pathologically increased (30 cm water). The atta
cks decreased during indomethacin treatment but 275 mg was needed for
satisfactory control of the attacks, i.e., more than the 150 mg which,
according to the criteria for CPH, should be absolutely effective. Su
matriptan was found to suppress the CPH attacks as well as indomethaci
n. Due to these findings CPH is considered to be another manifestation
of venous vasculitis. The beneficiary mechanism of indomethacin in CP
H is considered to be due partly to its anti-inflammatory effects and
partly to its reduction of the intracranial blood flow.