3.2 Paroxysmal hemicrania

A 45-year-old plumber describes short, intensely painful attacks above his left brow. He is clear that the pain never affects the right side. Each attack reaches a severe pitch almost from the outset and typically lasts around twelve minutes before easing. During attacks he cannot settle in the chair, getting up and pacing the consulting room until it passes. He reports around eight attacks on a typical bad day and reckons the running total now stands at twenty-three. He denies any change in vision and has had no vomiting with these episodes. He recalls that his attacks stopped completely within days of starting it, referring to a short course of indomethacin he was given.