Paroxysmal Pressing Headache Examined as a New Headache Syndrome

girl talking to her doctor
girl talking to her doctor
Investigators believe that they have found a new type of headache that is different from tension type headache or other primary headache because of spatial and temporal features.

According to a study published in Cephalalgia, paroxysmal pressing headache has been identified as a new headache syndrome marked by spontaneous attacks without accompaniments that last only a few minutes with pain located in 1 region of 1 side of the head, which can shift between episodes. The investigators of this prospective study sought to describe a series of patients seen over a 4-year period who reported a distinctive type of head pain with clinical features that did not meet criteria for any other primary headache syndrome.

The study sample included 14 patients (9 women and 5 men) ranging in age from 20 to 73 years. The participants all reported spontaneous headache attacks described as pressing and lasting 2 to 15 minutes each. The attacks were localized to any 1 region (frontal, temporal, parietal, or occipital) of 1 side of the head; in all but 2 patients, the location of the pain shifted between episodes. Pain intensity was described as mild (n=3), moderate (n=4), or severe (n=7), and no accompanying symptoms were reported. The frequency varied between patients, and patients were asymptomatic between episodes. Results from comprehensive physical and neurological exams were all considered normal. Among the sample, 7 patients tried pharmacological treatments: 1 responded to simple analgesics, 3 to other nonsteroidal anti-inflammatory drugs, 1 to indomethacin, and 1 to antidepressants.

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Although the clinical features were consistent with tension-type headaches, spatial features and temporal patterns were distinguished from tension-type or any other headache syndrome described to date. The investigators propose the head pain described in this study is a new syndrome, which they termed paroxysmal pressing headache. Alternately, they suggest the clinical picture of paroxysmal pressing headache may be eventually considered as a variant of tension-type headache or other primary headache. Currently, not enough data is available regarding therapeutic options for paroxysmal pressing headache.

Paroxysmal pressing headache is distinguished from other short-lasting headache syndromes in that multifocal pain is localized to 1 region on 1 hemicranium, which shifts between attacks. Spontaneity with no accompanying symptoms further sets it apart from other syndromes. Future research is needed to validate the study observations.

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Pareja JA, Álvarez M, Cárcamo A, Liaño T, Rodríguez-Caravaca G, Cuadrado ML. Paroxysmal pressing headache: a new short-lasting headache [published online January 6, 2019]. Cephalalgia. doi: 10.1177/0333102418821671

This article originally appeared on Neurology Advisor