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Rozen TD. Cigarette smoking history (personal and secondary childhood exposure) in non-cluster headache trigeminal autonomic cephalalgias: A clinic based study. Cephalalgia 2023; 43:3331024231208679. [PMID: 37882655 DOI: 10.1177/03331024231208679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
OBJECTIVE To look at cigarette smoking history (personal and secondary exposure as a child) in non-cluster headache trigeminal autonomic cephalalgias seen at a headache clinic and to determine smoking exposure prevalence utilizing previously published data. METHODS Retrospective chart review and PubMed/Google Scholar search. RESULTS Forty-eight clinic patients met ICHD-3 criteria for non-cluster headache trigeminal autonomic cephalalgias. Four had paroxysmal hemicrania, 75% were smokers and secondary exposure was noted in all. 16 patients had short lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) or short lasting unilateral neuralgiform headache attacks with autonomic symptoms (SUNA), 12.5% were smokers and secondary exposure was noted in 91%. Twenty-eight patients had hemicrania continua, 21% were smokers and secondary exposure was found in 62.5%.Since 1974 there have been 88 paroxysmal hemicrania, 50 SUNCT or SUNA and 89 hemicrania continua patients with a documented smoking exposure history. From current data and previous studies, a smoking history was noted in 60% paroxysmal hemicrania, 18% SUNCT and SUNA and 21% hemicrania continua patients. CONCLUSION A cigarette smoking history appears to be connected to paroxysmal hemicrania (personal and secondary exposure) and possibly to SUNCT/SUNA (secondary) and hemicrania continua (secondary).
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Affiliation(s)
- Todd D Rozen
- Department of Neurology, Mayo Clinic Florida, USA
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Al-Khazali HM, Christensen RH, Lambru G, Dodick DW, Ashina H. Hemicrania Continua: An Update. Curr Pain Headache Rep 2023; 27:543-550. [PMID: 37566220 DOI: 10.1007/s11916-023-01156-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2023] [Indexed: 08/12/2023]
Abstract
PURPOSE OF REVIEW Hemicrania Continua (HC) is a rare and disabling primary headache disorder that is characterized by persistent, unilateral headache with ipsilateral, cranial autonomic symptoms and restlessness or agitation. The diagnosis requires patients to experience an absolute response to therapeutic doses of indomethacin. RECENT FINDINGS HC is diagnosed in in about 1.8% of adult patients who were evaluated for headache in tertiary care services, albeit this estimate should be interpreted with caution. The most prevalent accompanying symptoms appear to be lacrimation, conjunctival injection and restlessness or agitation. However, the available literature is limited by methodologic issues, and the current diagnostic criteria lack clarity on what defines absolute response to indomethacin. More rigorous studies are thus needed to improve our understanding of HC which, in turn, will facilitate better disease management in clinical practice. Here, we provide a comprehensive overview of HC, including its epidemiology, clinical presentation, diagnostic evaluation, and management.
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Affiliation(s)
- Haidar M Al-Khazali
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Rune Häckert Christensen
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Giorgio Lambru
- The Headache and Facial Pain Service, Guy's and St Thomas' Hospitals NHS Trust, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - David W Dodick
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA
| | - Håkan Ashina
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Department of Brain and Spinal Cord Injury, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
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Stubberud A, Tronvik E, Matharu M. Treatment of SUNCT/SUNA, Paroxysmal Hemicrania, and Hemicrania Continua: An Update Including Single-Arm Meta-analyses. Curr Treat Options Neurol 2020. [DOI: 10.1007/s11940-020-00649-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Abstract
Purpose of Review
This review presents a critical appraisal of the treatment strategies for short-lasting unilateral neuralgiform headache attacks (SUNHA), paroxysmal hemicrania (PH), and hemicrania continua (HC). We assess the available, though sparse, evidence on both medical and surgical treatments. In addition, we present estimated pooled analyses of the most common treatments and emphasize recent promising findings.
Recent Findings
The majority of literature available on the treatment of these rare trigeminal autonomic cephalalgias are small open-label observational studies and case reports. Pooled analyses reveal that lamotrigine for SUNHA and indomethacin for PH and HC are the preventative treatments of choice. Second-line choices include topiramate, gabapentin, and carbamazepine for SUNHA; verapamil for PH; and cyclooxygenase-2 inhibitors and gabapentin for HC. Parenteral lidocaine is highly effective as a transitional treatment for SUNHA. Novel therapeutic strategies such as non-invasive neurostimulation, targeted nerve and ganglion blockades, and invasive neurostimulation, including implanted occipital nerve stimulators and deep brain stimulation, appears to be promising options.
Summary
At present, lamotrigine as a prophylactic and parenteral lidocaine as transitional treatment remain the therapies of choice for SUNHA. While, by definition, both PH and CH respond exquisitely to indomethacin, evidence for other prophylactics is less convincing. Evidence for the novel emerging therapies is limited, though promising.
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Abstract
PURPOSE OF REVIEW Hemicrania Continua (HC) is a daily and persistent form of headache that is characterized by side-locked pain which is continuous, varies in severity and can be associated with conjunctival injection, lacrimation, nasal congestion, rhinorrhea, eyelid edema, forehead or facial sweating and miosis and/or ptosis. RECENT FINDINGS Functional imaging studies have shown activation of subcortical structures such as the posterior hypothalamus and dorsal rostral pons, which are known to disinhibit the trigeminal autonomic reflex, a reflex responsible for autonomic outflow through trigeminal efferents. A similar pathway activation is seen in other Trigeminal autonomic cephalalgias (TAC) which solidifies HC as a TAC. While we also discuss promising treatments in our review, more evidence is needed before making them a standard of therapy for HC. This article aims to review the recent research on the diagnosis and clinical management of this potentially underdiagnosed primary headache disorder.
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Auffenberg E, Bender F, Freilinger T. Hemicrania Continua Associated with Classic Scintillating Scotoma. Case Rep Neurol 2018; 10:83-87. [PMID: 29681827 PMCID: PMC5903150 DOI: 10.1159/000487881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 02/21/2018] [Indexed: 01/03/2023] Open
Abstract
Hemicrania continua (HC) is a rare primary headache disorder, characterized by persistent unilateral pain associated with cranial autonomic symptoms and prompt response to indomethacin. While migrainous features (including aura) have been recognized in cluster headache, there have been only single reports of HC with aura. Here, we report the case of a 53-year-old man with constant right-sided headache and superimposed exacerbations to severe pain lasting for several hours. Secondary etiologies were excluded, and a diagnosis of HC was established after prompt and complete response to treatment with indomethacin. During an episode of pain exacerbation, for the first time the patient experienced an episode of transient visual disturbances compatible with scintillating scotoma. We propose a potential link between HC and visual aura, which parallels similar observations in other trigeminal autonomic cephalalgias and more specifically confirms previous observational data on aura in HC, thus highlighting potentially shared pathophysiological mechanisms.
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Affiliation(s)
- Eva Auffenberg
- Department of Neurology and Epileptology, Hertie-Institute for Clinical Brain Research (HIH), Tübingen, Germany
| | - Friedemann Bender
- Department of Neurodegeneration, Hertie-Institute for Clinical Brain Research (HIH), Tübingen, Germany
| | - Tobias Freilinger
- Department of Neurology and Epileptology, Hertie-Institute for Clinical Brain Research (HIH), Tübingen, Germany
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Abstract
Hemicrania continua (HC) is an indomethacin responsive primary chronic headache disorder which is currently classified as a subtype of trigeminal autonomic cephalalgias (TACs). It is not very uncommon. There are >1000 cases of HC in the literature, and it constitutes 1.7% of total headache in the clinic settings. Misdiagnosis for HC is very common at all clinical settings. A diagnosis of HC is missed even by neurologists and headache specialists. It is characterized by a continuous strictly unilateral headache with superimposed exacerbations. Just like other TACs, exacerbations are associated with cranial autonomic symptoms and restlessness. A large number of patients may have migrainous features (nausea, vomiting, photophobia, and phonophobia) during exacerbations phase. The “key” feature of HC is persistent featureless background headaches. However, patients and physicians may focus only on the exacerbation part. As durations, frequency and associated symptoms of exacerbations are highly variables; it may mimic a large number of primary and secondary headache disorders. Migraine and cluster headache are two most common misdiagnosed conditions. Another specific feature of HC is remarkable repose to indomethacin. A “complete” response to indomethacin is as “sine qua non” for HC. However, a few other medications may also be effective in a subset of HC patients. Various surgical procedures have been tried with mixed results in patients who were intolerant to indomethacin or other drugs.
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Affiliation(s)
- Sanjay Prakash
- Department of Neurology, Smt. B. K. Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth University, Vadodara, Gujarat, India
| | - Bansi Adroja
- Department of Medicine, Smt. B. K. Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth University, Vadodara, Gujarat, India
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Jay GW, Barkin RL. Primary Headache Disorders Part I- Migraine and the Trigeminal Autonomic Cephalalgias. Dis Mon 2017; 63:308-338. [DOI: 10.1016/j.disamonth.2017.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Baraldi C, Pellesi L, Guerzoni S, Cainazzo MM, Pini LA. Therapeutical approaches to paroxysmal hemicrania, hemicrania continua and short lasting unilateral neuralgiform headache attacks: a critical appraisal. J Headache Pain 2017; 18:71. [PMID: 28730562 PMCID: PMC5519518 DOI: 10.1186/s10194-017-0777-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 07/04/2017] [Indexed: 12/30/2022] Open
Abstract
Background Hemicrania continua (HC), paroxysmal hemicrania (PH) and short lasting neuralgiform headache attacks (SUNCT and SUNA) are rare syndromes with a difficult therapeutic approach. The aim of this review is to summarize all articles dealing with treatments for HC, PH, SUNCT and SUNA, comparing them in terms of effectiveness and safety. Methods A survey was performed using the pubmed database for documents published from the 1st January 1989 onwards. All types of articles were considered, those ones dealing with symptomatic cases and non-English written ones were excluded. Results Indomethacin is the best treatment both for HC and PH. For the acute treatment of HC, piroxicam and celecoxib have shown good results, whilst for the prolonged treatment celecoxib, topiramate and gabapentin are good options besides indomethacin. For PH the best drug besides indomethacin is piroxicam, both for acute and prolonged treatment. For SUNCT and SUNA the most effective treatments are intravenous or subcutaneous lidocaine for the acute treatment of active phases and lamotrigine for the their prevention. Other effective therapeutic options are intravenous steroids for acute treatment and topiramate for prolonged treatment. Non-pharmacological techniques have shown good results in SUNCT and SUNA but, since they have been tried on a small number of patients, the reliability of their efficacy is poor and their safety profile mostly unknown. Conclusions Besides a great number of treatments tried, HC, PH, SUNCT and SUNA management remains difficult, according with their unknown pathogenesis and their rarity, which strongly limits the studies upon these conditions. Further studies are needed to better define the treatment of choice for these conditions. Electronic supplementary material The online version of this article (doi:10.1186/s10194-017-0777-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carlo Baraldi
- Medical Toxicology - Headache and Drug Abuse Centre, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy.
| | - Lanfranco Pellesi
- Medical Toxicology - Headache and Drug Abuse Centre, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - Simona Guerzoni
- Medical Toxicology - Headache and Drug Abuse Centre, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - Maria Michela Cainazzo
- Medical Toxicology - Headache and Drug Abuse Centre, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - Luigi Alberto Pini
- Medical Toxicology - Headache and Drug Abuse Centre, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
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Abstract
Hemicrania continua (HC) is an indomethacin-responsive primary headache disorder which is currently classified under the heading of trigeminal autonomic cephalalgias (TACs). It is a highly misdiagnosed and underreported primary headache. The pooled mean delay of diagnosis of HC is 8.0 ± 7.2 years. It is not rare. We noted more than 1000 cases in the literature. It represents 1.7% of total headache patients attending headache or neurology clinic. Just like other TACs, it is characterized by strictly unilateral pain in the trigeminal distribution, cranial autonomic features in the same area and agitation during exacerbations/attacks. It is different from other TACs in one aspect. While all other TACs are episodic, HC patients have continuous headaches with superimposed severe exacerbations. The central feature of HC is continuous background headache. However, the patients may be worried only for superimposed exacerbations. Focusing only on exacerbations and ignoring continuous background headache are the most important factors for the misdiagnosis of HC. A large number of patients may have migrainous features during exacerbation phase. Up to 70% patients may fulfill the diagnostic criteria for migraine during exacerbations. Besides migraine, its exacerbations can mimic a large number of other primary and secondary headaches. The other specific feature of HC is a remarkable response to indomethacin. However, a large number of patients develop side effects because of the long-term use of indomethacin. A few other medications may also be effective in a subset of patients with HC. Various surgical interventions have been suggested for patients who are intolerant to indomethacin. Several aspects of HC are still not defined. There is a great heterogeneity in types of patients or articles on the HC in the literature. Diagnostic criteria have been modified several times over the years. The current diagnostic criteria are too restrictive in some aspects. We suggest a more accommodating type of criteria for the appendix of International Classification of Headache Disorder (ICHD).
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Affiliation(s)
- Sanjay Prakash
- Department of Neurology, Smt. B. K. Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth University, Vadodara, Gujarat, India
| | - Payal Patel
- Department of Neurology, Cleveland Clinic Foundation, Cleveland, OH, USA
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Alim-Marvasti A, Ho J, Weatherall M, Patel M, George S, Viegas S. Trigeminal autonomic cephalgia caused by recurrent posterior scleritis. Pract Neurol 2016; 16:455-457. [PMID: 27495133 DOI: 10.1136/practneurol-2016-001433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2016] [Indexed: 01/10/2023]
Abstract
A 40-year-old woman presented with a side-locked headache with autonomic features, which then switched sides before reverting to the original side. The atypical features of side swapping, partial response to indometacin and abnormal optic disc appearances ultimately led to a diagnosis of recurrent posterior scleritis. We discuss the differential diagnosis of trigeminal autonomic cephalgias and its secondary causes, and provide practical pointers for its investigation and management.
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Affiliation(s)
- Ali Alim-Marvasti
- Department of Neurology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Jason Ho
- Department of Ophthalmology, Hillingdon Hospitals NHS Foundation Trust, Uxbridge, Hillingdon, UK
| | - Mark Weatherall
- Department of Neurology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Maneesh Patel
- Department of Neuroradiology, Imperial College Healthcare NHS Trust, London, UK
| | - Sheena George
- Department of Ophthalmology, Hillingdon Hospitals NHS Foundation Trust, Uxbridge, Hillingdon, UK
| | - Stuart Viegas
- Department of Neurology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
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Abstract
Indomethacin-responsive headaches are a heterogeneous group of primary headache disorders distinguished by their swift and often absolute response to indomethacin. The epidemiology of these conditions is incompletely defined. Traditionally, indomethacin-responsive headaches include a subset of trigeminal autonomic cephalalgias (paroxysmal hemicrania and hemicrania continua), Valsalva-induced headaches (cough headache, exercise headache, and sex headache), primary stabbing headache, and hypnic headache. These headache syndromes differ in extent of response to indomethacin, clinical features, and differential diagnoses. Neuroimaging is recommended to investigate for various organic causes that may mimic these headaches. Case reports of other primary headache disorders that also respond to indomethacin, such as cluster headache, nummular headache, and ophthalmoplegic migraine, have been described. These "novel" indomethacin-responsive headaches beg the question of what headache characteristics are required to qualify a headache as an indomethacin-responsive headache. Furthermore, they challenge the concept of using a therapeutic intervention as a diagnostic criterion.
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Abstract
The trigeminal autonomic cephalalgias include cluster headache, paroxysmal hemicrania, short-lasting unilateral neuralgiform headache attacks, and hemicrania continua. While the majority responds to conventional pharmacological treatments, a small but significant proportion of patients are intractable to these treatments. In these cases, alternative choices for these patients include oral and injectable drugs, lesional or resectional surgery, and neurostimulation. The evidence base for conventional treatments is limited, and the evidence for those used beyond convention is more so. At present, the most evidence exists for nerve blocks, deep brain stimulation, occipital nerve stimulation, sphenopalatine ganglion stimulation in chronic cluster headache, and microvascular decompression of the trigeminal nerve in short-lasting unilateral neuralgiform headache attacks.
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Affiliation(s)
- Sarah Miller
- Headache Group, Institute of Neurology, Queen Square, London, WC1N 3BG, UK
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Zhu S, McGeeney B. When Indomethacin Fails: Additional Treatment Options for “Indomethacin Responsive Headaches”. Curr Pain Headache Rep 2015; 19:7. [DOI: 10.1007/s11916-015-0475-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Fantini J, Koscica N, Zorzon M, Belluzzo M, Granato A. Hemicrania continua with visual aura successfully treated with a combination of indomethacin and topiramate. Neurol Sci 2014; 36:643-4. [PMID: 25501961 DOI: 10.1007/s10072-014-2036-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Accepted: 12/06/2014] [Indexed: 01/03/2023]
Affiliation(s)
- Jacopo Fantini
- Department of Medical, Surgical and Health Sciences, Neurologic Clinic, Headache Centre, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy,
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Napchan U. Hemicrania Continua. Headache 2013. [DOI: 10.1002/9781118678961.ch19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Prakash S, Golwala P. A proposal for revision of hemicrania continua diagnostic criteria based on critical analysis of 62 patients. Cephalalgia 2012; 32:860-8. [PMID: 22751966 DOI: 10.1177/0333102412452043] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Misdiagnosis of hemicrania continua (HC) is common. It is diagnosed according to the criteria of the International Headache Society (IHS), but in clinical practice, these criteria seem too restrictive and many hemicrania continua-like headaches remain unclassified. SUBJECTS AND METHODS We retrospectively studied the patients fulfilling the IHS criteria for HC. In addition, we identified a group of patients who met all criteria minus cranial autonomic features (HC-A) or minus a complete response to indomethacin (HC-I). We compared epidemiological profiles, clinical features and therapeutic responses to drug(s) between the groups. In addition, we reviewed the literature and critically analysed the diagnostic criteria for HC. RESULTS Sixty-two patients with a putative diagnosis of HC were identified. Thirty patients (48%) fulfilled the IHS criteria for HC. Thirty-two (52%) patients failed to satisfy one of the features of HC. Thirteen patients (21%) did not show any evidence of cranial autonomic feature during the episodes of the exacerbations (HC-A). Another 19 patients (31%) did not show a complete response to indomethacin (HC-I). Epidemiological and clinical features of all three groups were compared. None of the differences were statistically significant. In review of the literature, we noted that cranial autonomic features, a sense of restlessness/agitation during exacerbations, and response to indomethacin (marked to complete) are the specific features of HC. However, these features may not all be present in all cases. CONCLUSION Present diagnostic criteria are too restrictive. We suggest adding the site of pain in the criteria, as described for trigeminal autonomic cephalalgias. Cranial autonomic features, a sense of restlessness during exacerbations, and marked to complete response to indomethacin are three characteristics features of HC. We suggest that the presence of any two may be sufficient to diagnose HC.
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Affiliation(s)
- Sanjay Prakash
- Department of Neurology, Medical College, SSG Hospital, Baroda, Gujarat, India.
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Pareja JA, Cuadrado ML, Fernández-de-las-Peñas C, Montojo T, Álvarez M, López-de-Silanes C. Primary continuous unilateral headaches: a nosologic model for hemicrania continua. Cephalalgia 2012; 32:413-8. [PMID: 22407660 DOI: 10.1177/0333102412441088] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hemicrania continua was originally described as a strictly unilateral, continuous headache with an absolute response to indomethacin. Recognition of an increasing number of patients with the same clinical features except for a lack of response to indomethacin has generated controversy about whether the responsive/non-responsive phenotypes belong to the same disorder. DISCUSSION We suggest that the non-responsive phenotype should be differentiated from the original concept of hemicrania continua, because it probably indicates a separate type of headache of undetermined nature, i.e. hemicrania incerta. However, differentiating hemicrania incerta from hemicrania continua does not imply that the two headaches are unrelated. Both hemicranias may outline a continuum, giving rise to a broader diagnostic field. CONCLUSION There seems to be a syndrome of 'primary continuous unilateral headache' with at least two distinctive categories: hemicrania continua and hemicrania incerta, which are differentiated by their respective response to indomethacin. This division means plurality but adds precision, and allows a clear-cut diagnosis of some controversial cases.
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Affiliation(s)
- Juan A Pareja
- Fundación Alcorcón University Hospital, Alcorcón, Madrid, Spain.
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Rossi P, Tassorelli C, Allena M, Ferrante E, Lisotto C, Nappi G. Focus on therapy: hemicrania continua and new daily persistent headache. J Headache Pain 2010; 11:259-65. [PMID: 20186563 PMCID: PMC3451920 DOI: 10.1007/s10194-010-0194-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Accepted: 01/25/2010] [Indexed: 11/28/2022] Open
Abstract
Hemicrania continua (HC) and new daily-persistent headache (NDPH) represent the only two forms of chronic daily headache in Chap. IV "Other Primary Headaches" of the second edition of the International Classification of Headache Disorders. HC and NDPH are rare and poorly defined from a pathophysiological point of view; as a consequence, their management is largely empirical. Indeed, there is a lack of prospective, controlled trials in this field, and treatment effectiveness is basically inferred from the results of sparse open-label trials, retrospective case series, clinical experience and expert opinions. In this narrative review we have summarised the information collected from an extensive analysis of the literature on the treatment of HC and NDPH in order to provide the best available and up-to-date evidence for the management of these two rare forms of primary headache. Indomethacin is the mainstay of HC management. The reported effective dose of indomethacin ranges from 50 to 300 mg/day. Gabapentin 600-3,600 mg tid, topiramate 100 mg bid, and celecoxib 200-400 mg represent the most interesting alternative choices in the patients who do not tolerate indomethacin or who have contraindications to its use. NDPH is very difficult to treat and it responds poorly only to first-line options used for migraine or tension-type headache.
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Affiliation(s)
- Paolo Rossi
- Headache Clinic INI Grottaferrata, Rome, Italy
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Garza I, Cutrer FM. Pain relief and persistence of dysautonomic features in a patient with hemicrania continua responsive to botulinum toxin type A. Cephalalgia 2009; 30:500-3. [DOI: 10.1111/j.1468-2982.2009.01918.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- I Garza
- Mayo Clinic Department of Neurology, Rochester, MN, USA
| | - FM Cutrer
- Mayo Clinic Department of Neurology, Rochester, MN, USA
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Spears RC. Is gabapentin an effective treatment choice for hemicrania continua? J Headache Pain 2009; 10:271-5. [PMID: 19437100 PMCID: PMC3451742 DOI: 10.1007/s10194-009-0126-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2009] [Accepted: 04/20/2009] [Indexed: 12/18/2022] Open
Abstract
The objective of this study is to examine the efficacy of gabapentin for the treatment of hemicrania continua (HC) in cases where patients had difficulty tolerating indomethacin due to adverse effects. A retrospective chart review of nine patients with HC between October 2006 and February 2008. Inclusion criteria included men and women age 18 or above presenting to the headache center with a headache that meets International Headache Society criteria for HC including a response to indomethacin, but were not able to continue on indomethacin secondary to adverse effects. Four patients report being pain free, three patients report a 50-80% reduction of pain, one patient reports a 10% reduction of pain, and one patient reports no change in pain. Seven out of nine patients demonstrated at least a 50% reduction of pain on gabapentin, four patients becoming completely pain free.
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Abstract
Hemicrania continua (HC) is a primary headache disorder characterized by a continuous, moderate to severe, unilateral headache and defined by its absolute responsiveness to indomethacin. However, some patients with the clinical phenotype of HC do not respond to indomethacin. We reviewed the records of 192 patients with the putative diagnosis of HC and divided them into groups based on their headaches' response to indomethacin. They were compared for age, gender, presence or absence of specific autonomic symptoms, medication overuse, rapidity of headache onset, and whether or not the headaches met criteria for migraine when severe. Forty-three patients had an absolute response and 122 patients did not respond to adequate doses of indomethacin. The two groups did not differ significantly in terms of age, sex, presence of rapid-onset headache, or medication overuse. Autonomic symptoms, based on a questionnaire, did not predict response. Eighteen patients could not complete a trial of indomethacin due to adverse events. Nine patients could not be included in the HC group despite improvement with indomethacin: one patient probably had primary cough headache, another paroxysmal hemicrania; three patients improved but it was uncertain if they were absolutely pain free, and four patients dramatically improved but still had a baseline headache. We found no statistically significant differences between patients who did and did not respond to indomethacin. All patients with continuous, unilateral headache should receive an adequate trial of indomethacin. Most patients with unilateral headache suggestive of HC did not respond to indomethacin.
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Affiliation(s)
- MJ Marmura
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
| | - SD Silberstein
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
| | - M Gupta
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
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Is there need to search for alternatives to indomethacin for hemicrania continua? Case reports and a review. J Neurol Sci 2009; 277:187-90. [DOI: 10.1016/j.jns.2008.10.027] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2008] [Revised: 10/23/2008] [Accepted: 10/31/2008] [Indexed: 11/18/2022]
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Allena M, Tassorelli C, Sances G, Guaschino E, Sandrini G, Nappi G, Antonaci F. Is hemicrania continua a single entity or the association of two headache forms? Considerations from a case report. Headache 2008; 50:877-81. [PMID: 19178576 DOI: 10.1111/j.1526-4610.2008.01288.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Hemicrania continua (HC) belongs to the group of primary headaches and it is characterized by a strictly unilateral, continuous headache of moderate intensity, with superimposed exacerbations of severe intensity that are accompanied by trigeminal autonomic features. The syndrome is completely responsive to indomethacin. Here we report a case of a 49-year-old man with HC, which may be viewed as a combination of different types of headache, ie, chronic tension-type headache and trigeminal autonomic cephalalgia. The analysis of this case raises interesting issues regarding the proper place of HC among the primary headache forms.
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Affiliation(s)
- Marta Allena
- University Centre for the Study of Adaptive Disorders and Headache, University of Pavia and Headache Centre, IRCCS C Mondino Institute of Neurology Foundation, Pavia, Italy
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31
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Straube A, May A, Kropp P, Katsarava Z, Haag G, Lampl C, Sándor P, Diener HC, Evers S. Therapie primärer chronischer Kopfschmerzen. Schmerz 2008; 22:531-34, 536-40, 542-3. [DOI: 10.1007/s00482-008-0645-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Baldacci F, Nuti A, Cafforio G, Lucetti C, Logi C, Cipriani G, Orlandi G, Bonuccelli U. 'INDOTEST' in atypical hemicrania continua. Cephalalgia 2008; 28:300-1. [PMID: 18254899 DOI: 10.1111/j.1468-2982.2007.01525.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Hemicrania continua (HC) is an indomethacin-responsive headache characterized by a chronic, strictly unilateral, side-locked without side-shifting, persistent headache. We report three cases of HC with atypical features in which an acute administration of indomethacin 50 mg IM (INDOTEST) was performed. In all three cases INDOTEST predicted chronic responsiveness to indomethacin. Thus, in cases of HC with atypical features, INDOTEST could help for a correct diagnosis and therapy.
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Affiliation(s)
- F Baldacci
- Department of Neurosciences, University of Pisa, Pisa, Italy.
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Camarda C, Camarda R, Monastero R. Chronic paroxysmal hemicrania and hemicrania continua responding to topiramate: Two case reports. Clin Neurol Neurosurg 2008; 110:88-91. [DOI: 10.1016/j.clineuro.2007.09.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Revised: 08/29/2007] [Accepted: 09/10/2007] [Indexed: 11/27/2022]
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Abstract
The trigeminal autonomic cephalgias include cluster headache, paroxysmal hemicrania, and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT). The evidence for the current treatment options for each of these syndromes is considered, including oxygen, sumatriptan, and verapamil in cluster headache, indomethacin in paroxysmal hemicrania, and intravenous lidocaine and lamotrigine in SUNCT. Some treatments such as topiramate have an effect in all of these, as well as in migraine and other pain syndromes. The involvement of the hypothalamus in functional imaging studies implies that this may be a substrate for targeting treatment options in the future.
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Affiliation(s)
- Anna S Cohen
- Institute of Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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Brighina F, Palermo A, Cosentino G, Fierro B. Prophylaxis of Hemicrania Continua: Two New Cases Effectively Treated With Topiramate. Headache 2007; 47:441-3. [PMID: 17371364 DOI: 10.1111/j.1526-4610.2007.00733.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Hemicrania continua (HC) is an uncommon and under-recognized primary headache disorder characterized by a strictly unilateral continuous headache of moderate intensity with possible exacerbations and associated with ipsilateral autonomic features. HC has generally a prompt and enduring response to indomethacin although 25% to 50% of treated patients develop gastrointestinal side effects. These cases pose a difficult management challenge as no other drug is consistently effective in HC. Recently 2 HC patients responsive to topiramate treatment have been reported. Here we describe 2 more patients effectively treated with topiramate. Neither reported any side effects and one had persisting response for 6 months after drug withdrawal.
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