Paroxysmal hemicrania is manifested by headache attacks with the same pain characteristics and accompanying symptoms as cluster headaches. However, the attacks last shorter, occur much more frequently, predominantly affect women and respond absolutely reliably to indomethacin. Paroxysmal hemicrania can also occur secondary to an apparent cause. Careful diagnostics are required to rule out symptomatic paroxysmal hemicrania, especially in the case of an atypical clinical presentation and poor response to indomethacin.

SUNCT syndrome is characterized by short-lasting unilateral pain attacks that are significantly shorter than in other trigemino-autonomic headache disorders. Typically, marked lacrimation and conjunctival injection occur ipsilateral to the pain. Some patients have been described with both cluster headache and trigeminal neuralgia . These patients should receive both diagnoses. The importance of differentiation lies in the fact that both diseases must be treated specifically in order to achieve freedom from pain.

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