Hemicrania Continua

Abstract

In recent years, hemicrania continua has become a well-recognized primary headache disorder known for its chronicity and resulting disability in a subset of patients with headache. The core clinical features have been well described: unilateral, side-locked headaches that are continuous (although interrupted by frequent severe exacerbations), associated with autonomic symptoms and a response to indomethacin. However, areas of relative controversy remain in its classification and diagnosis. Several relatively large case series have better delineated the associated features of this disorder, including atypical presentations. Recently, neuroimaging research has provided new insights into the underlying pathways involved in the disorder, in particular activation of the contralateral posterior hypothalamus and the ipsilateral dorsal rostral pons. Despite its well-known response to indomethacin, many patients still endure long delays in the appropriate diagnosis and treatment. There remains a need for new treatments given the morbidity associated with long-term indomethacin use.

Migraine Mimics

“…Charlson and Robbins recommend titrating up from 75 mg daily to 150 mg daily to 225 mg daily with each dose tried for 5 days. There are rare reports of response at 300 mg daily …”

“…There are rare reports of response at 300 mg daily. 12 The lowest effective dose of indomethacin should be used because of the risk of side effects including abdominal pain, dizziness, nausea and/or vomiting, diarrhea, ulcer disease, renal impairment, and association with adverse cardiovascular thrombotic events. Some patients may respond to doses as low as 25-50 mg daily.…”

A Case Report of Hemicrania Continua‐Like Headache Due to Ipsilateral Inflammatory Orbital Pseudotumor

“…1 In this report, we describe a patient that presents with a HC-like headache due to orbital pseudotumor. About a third of sufferers report an ipsilateral ocular foreign body sensation or itch.…”

“…As with all trigeminal autonomic cephalgias, imaging should be performed if a patient presents with HC or HC-like headaches in order to rule out any underlying pathology. 1 In this report, we describe a patient that presents with a HC-like headache due to orbital pseudotumor.…”

“…Pituitary adenoma, brainstem infarct, internal carotid aneurysm, internal carotid dissection, metastatic lung carcinoma, nonmetastatic lung cancer, osteoid osteoma, pineal cyst, trauma, leprosy, and post-partum cases have all been described in secondary HC. 1 Therefore, it should be noted that indomethacin responsiveness does not rule out a secondary etiology. Our patient responded robustly to indomethacin prior to the administration of steroids.…”