3.2 Paroxysmal hemicrania

A 52-year-old farmer reports brief but very severe headaches over the past four months. The pain sits above his left eyebrow, has never once been felt on the other side, and climbs to a severe level within moments of starting. During the attacks his left eyelid becomes visibly puffy for the duration of each attack, settling back to normal once it passes. Each attack is short, lasting around eight minutes on his own count. He experiences up to six such attacks on his busiest days and estimates he has had twenty-one since they began. He reports no tearing of the eye and no blocked nose. He says the attacks had stopped completely while taking it, referring to a trial of indomethacin.