Chronic paroxysmal hemicrania in an adult responding to valproate: a case report

Chronic paroxysmal hemicrania (CPH) is a rare primary headache syndrome classified as a trigeminal autonomic cephalalgia. It is characterized by repeated attacks of severe, strictly unilateral and short-lasting pain occurring with cranial autonomic features. The absolute response to indomethacin represents the diagnostic key. Unfortunately, often, treatment with indomethacin may cause adverse events, mostly gastrointestinal. We report the case of a 53-year-old male affected by CPH responding to indomethacin, which had to be withdrawn because of gastric side effects. He had a subsequent good and prolonged response to valproate. Our observation suggests the potential use of valproate as a treatment option in patients with CPH with contraindications or intolerance to indomethacin.