BMJ Case Reports 2009; doi:10.1136/bcr.06.2009.2007
  • Findings that shed new light on the possible pathogenesis of a disease or an adverse effect

Paroxysmal hemicrania responding to topiramate

  1. A S Cohen,
  2. P J Goadsby
  1. Headache Group, Institute of Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
  1. P J Goadsby, peterg{at}
  • Published 7 July 2009


Chronic paroxysmal hemicrania (CPH) is a rare primary headache syndrome, which is classified along with cluster headache and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) as a trigeminal autonomic cephalalgia. CPH is exquisitely responsive to indomethacin, so much so that the response is one of the current diagnostic criteria. The case of a patient with CPH, who had marked epigastric symptoms with indomethacin treatment and responded well to topiramate 150 mg daily, is reported. Cessation of topiramate caused return of episodes, and the response has persisted for 2 years. Topiramate may be a treatment option in CPH.


  • Competing interests: None.

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