Extratrigeminal Episodic Paroxysmal Hemicrania. Further Clinical Evidence of Functionally Relevant Brain Stem Connections


Address all correspondence to Dr. David W. Dodick, Department of Neurology, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905.


A woman, aged 59 years, developed a constant, left, occipital headache associated with episodes of discrete exacerbations occurring three to five times daily for 3 days, each lasting 15 to 20 minutes, and associated with left ptosis, conjunctival injection, and redness of the left ear. Pain-free remissions, which usually lasted 2 weeks, ceased after a mild neck injury, but the headaches responded promptly to indomethacin.

This case, illustrating a transition from an occipital episodic to chronic paroxysmal hemicrania, is discussed as a variation of the trigeminal-autonomic cephalalgias.