3.2.2 Chronic paroxysmal hemicrania (CPH)

A 39-year-old pharmacist has developed severe, one-sided headache attacks nearly every day over the past year. The pain sits just above the eye and is severe enough to make her restless, pacing behind the counter or shifting her weight constantly until each attack eases, about twenty minutes after it begins. On her worst days she can count nine separate attacks, and she thinks the lifetime tally is somewhere past 3000 attacks. The pattern has continued without a real break for twelve months, and the longest lull she can recall lasted around three months at most. Indomethacin at a full treatment dose ends the pain completely each time she takes it.