A Case Of Probable Paroxysmal Hemicrania Mistaken For Cervicogenic Headache

Abstract

Objectives: To describe a unique case of probable paroxysmal hemicrania which was mistaken for cervicogenic headache and to investigate reasons for misdiagnosis, which includes imperfect diagnostic criteria, unique pathophysiology, and inadequate headache education in the field of pain medicine. Case report: We present a sixty-six-year-old female with multiple disorders of the cervical spine and a two-year history of left-sided neck pain and headache. She was seen by multiple specialists and originally assumed to have cervicogenic headache. She did not respond to conservative measures or medial branch block. Ultimately, she was suspected to have paroxysmal hemicrania, despite her not having obvious autonomic features. She obtained complete relief with indomethacin. Conclusions: Trigeminal autonomic cephalalgias such as paroxysmal hemicrania and hemicrania continua can be mistaken for cervicogenic headache. The diagnostic criteria for cervicogenic headache should be better defined. Cervicogenic headache and the trigeminal autonomic cephalalgias, including paroxysmal hemicrania, can refer pain to various areas of the head and neck.1-4 This occurs via convergent afferent fibers and the trigeminocervical complex. 5-7 This overlapping symptomatology and pathophysiology explains how misdiagnosis of certain headache disorders can occur. Lastly, it is imperative that pain medicine providers have adequate training in headache medicine.