We report two patients with ipsilateral attacks of
cluster headache and
chronic paroxysmal hemicrania. The first patient, a 33-year-old man, started having attacks of
chronic cluster headache at the age of 27. At 33, they were replaced by typical attacks of ipsilateral
chronic paroxysmal hemicrania which showed a dramatic improvement with
indomethacin 150 mg daily. After two days of complete remission,
cluster headache attacks reappeared and persisted until
verapamil, 360 mg a day, was added to
indomethacin. The second patient, a 45-year-old man, first developed attacks of
episodic cluster headache at the age of 35. At 44, he experienced ipsilateral typical attacks of
chronic paroxysmal hemicrania, and two months later attacks of
cluster headache. Under
verapamil 240 mg daily, attacks of
cluster headache disappeared, but those of
chronic paroxysmal hemicrania increased in frequency until
indomethacin 150 mg daily was added. These observations suggest a close relationship but not a similarity between
cluster headache and chronic paraoxysmal
hemicrania, and show the practical therapeutic interest of maintaining this distinction.