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This report is the first of its kind documented in literature.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Case presentation<\/jats:title>\n<jats:p>This was an elderly, sixty-five-year-old Chinese male who presented with a headache fulfilling criteria of paroxysmal hemicrania and was found to have signs of ipsilateral conjunctival injection, Horner\u2019s syndrome, weakness and loss of sensation; with resolution of the patient\u2019s physical signs after relief of the headache. Brain magnetic resonance imaging did not show any strokes or other headache mimics. The patient had a marked response to indomethacin and a decrease of headache intensity and frequency with indomethacin prophylaxis.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Paroxysmal hemicrania has joined the list of stroke chameleons and that it would be one of the differentials in a patient with hemiplegia, hemisensory loss, autonomic signs and severe headache. It suggests that paroxysmal hemicrania in the elderly present atypically.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s12877-020-01768-5","type":"journal-article","created":{"date-parts":[[2020,10,7]],"date-time":"2020-10-07T13:03:57Z","timestamp":1602075837000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Paroxysmal hemicrania masquerading as a stroke in an elderly gentleman: case report"],"prefix":"10.1186","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6710-1701","authenticated-orcid":false,"given":"Boon Hian","family":"Tan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Astrid Melani","family":"Suantio","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yeow Hoay","family":"Koh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,10,7]]},"reference":[{"issue":"1","key":"1768_CR1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1177\/0333102417738202","volume":"38","author":"International Headache Society 2018","year":"2018","unstructured":"International Headache Society 2018. 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