Q. I have suffered from chronic paroxysmal hemicranias (CPH) for six years. Although I do get relief from indomethacin, I am wondering if there are any other treatment options that have shown success in CPH patients. My doctor suggested calcium channel blockers, but because they cause constipation and low blood pressure, it is not an option for me.
I saw the recent letter about daily headaches in the Sept. 16 NHF News to Know member e-newsletter. Botox was a suggestion. Could this work for CPH? – Cindy W.
A. Botox has been shown to be effective in patients with one subset of chronic daily headache, specifically chronic migraine. Another subset of chronic daily headache, chronic tension-type headache, has not shown any benefit from Botox administration. There is no significant data for Botox in CPH, and we have no clinical experience with its use in this condition either. Indomethacin responsiveness is a hallmark of CPH, and in fact is required to arrive at that diagnosis. It has been my experience that indomethacin works dramatically for this disorder while other medical treatments are almost always ineffective.
Robert G. Kaniecki, MD, University of Pittsburgh
