Chronic Paroxysmal Hemicrania with Trigeminal Neuralgia: the CPH-tic Syndrome

Background: In 1993 Hannerz described the syndrome, chronic paroxysmal hemicrania which occurs simultaneously with trigeminal neuralgia, the CPH-tic syndrome. This extremely painful syndrome always occurs in the same patients on the same side of the face. This syndrome is very difficult to diagnose and so such patients are frequently given the wrong treatment.
Case Report: The present author describes cases of this syndrome in two female patients, one 61 years old, the other 73. Patient No 1 had been treated as an out-patient for pain (probably type CPH) in the
left cheek but no improvement of her condition was achieved. Then pains of the tic-doloreux type
also occurred on the same side of her face. The out-patient treatment gave little effect. It was only
when she was treated in a hospital neurological department and indomethacin was added to the
tic doloreux treatment that a marked improvement was noted. Patient No 2. This patient suffered from intolerable pains in the right half of her face and forehead, treated in the out-patients clinic for neuralgia of the 1st and 2nd divisions of the trigeminal nerve without any significant improvement. Complete alleviations of the pains only occurred when she was treated in the Neurological Department where indomethacin was added to the treatment for
tic-doloreux.
Conclusions: 1. Concomitant occurrence of the CPH and tic-doloreux syndromes on the same side of the face
in the same patient is difficult to diagnose.
2. In case of such patients, indomethacin should be added to the usual treatment of trigeminal
neuralgia.

Keywords: CPH-tic syndrome, chronic paroxysmal hemicrania, Trigeminal Neuralgia