3.2.2 Chronic paroxysmal hemicrania (CPH)

A 52-year-old farmer has been troubled by brief but severe head pain for the last year, occurring almost daily. The pain settles around and behind one eye, always on the same side, and climbs to a severe intensity within a couple of minutes. His eyelid on that side swells visibly while an attack is under way, and each spell lasts close to twelve minutes before it lifts. He can have as many as eight attacks in a single day, and by his own reckoning the total over the past year adds up to something near 3000 attacks. The whole run has been continuous for twelve months, with no gap ever stretching past roughly three months. A full dose of indomethacin resolves the pain completely every time he takes it.