Hemicrania continua: Case series presenting in an orofacial pain clinic

Hryvenko, Iryna; Cervantes-Chavarría, Andrés R.; Law, Alan S.; Nixdorf, Donald R.

doi:10.1177/0333102418764895

Cited by 17 publications

(20 citation statements)

References 26 publications

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“…Traditionally, HC has been considered a rare condition and a recent study by Hryvenko and colleagues reviewed 1617 new patients seen in their TMD and Orofacial Pain Clinic, and only found 6 (0.4%) patients with HC, with 5 patients with nearly complete response with oral indomethacin (150-225 mg/day) and one patient had to remain on 75 mg/day due to intolerable side effects, and therefore had partial pain relief [21]. In a pooled analysis of published HC case series, HC represents 1.7% (range 1.3–2.3%) of neurology or headache clinics patients [22].…”

Section: Discussionmentioning

confidence: 99%

Trigeminal autonomic cephalalgias presenting in a multidisciplinary tertiary orofacial pain clinic

et al. 2019

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Orofacial pain may have a variety of causes and offers a significant clinical challenge for its diagnosis and management.ObjectiveTo assess the headache disorders presenting in a tertiary multidisciplinary orofacial pain clinic, after dental causes have been excluded.MethodsClinic letters from the initial consultation and subsequent follow up reviews of the 142 patients, who were seen in the tertiary Multidisciplinary Orofacial Pain clinic between January 2015 until January 2018 were reviewed as a clinical audit.ResultsThe most common diagnoses were possible trigeminal autonomic cephalalgia (n = 62, 44%), migraine (n = 38, 27%) and painful post-traumatic trigeminal neuropathy (n = 17, 12%). The most common trigeminal autonomic cephalalgia diagnosis was hemicrania continua (n = 13, 9%), which is higher than the reported prevalence in neurology and headache clinics.ConclusionThis study demonstrates the importance of a multidisciplinary approach to diagnosing complex orofacial pain patients and the importance of awareness of primary headache disorders, in particular trigeminal autonomic cephalalgias, thereby reducing unnecessary diagnostic delays or procedures.

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Section: Discussionmentioning

confidence: 99%

Trigeminal autonomic cephalalgias presenting in a multidisciplinary tertiary orofacial pain clinic

et al. 2019

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“…The literature search for HC yielded 48 records. Ten studies [13,17,[22][23][24][25][26][27][28][29] with a total of 131 patients were included in the pooled analyses.…”

Section: Methodsmentioning

confidence: 99%

“…In the second series, the mean effective dose was 78 mg [17]. Pooled analysis of four studies [17,24,26,27] with a total of 82 participants showed a responder proportion of 1.0 (95% CI 0.98 to 1.00). After achieving headache relief, it is often advisable to find the lowest maintenance dose [17,27].…”

Section: Preventative Treatmentmentioning

confidence: 96%

Treatment of SUNCT/SUNA, Paroxysmal Hemicrania, and Hemicrania Continua: An Update Including Single-Arm Meta-analyses

Stubberud

Tronvik

Matharu

2020

Curr Treat Options Neurol

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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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“…Hemicrania continua is a rare entity, found between 1.3 and 2.3% of all patients seen in headache clinics (1,6,7). Its incidence on the general population is di cult to estimate due to the lack of reported case or cases that go underdiagnosed(8).…”

Section: Introductionmentioning

confidence: 99%

Hemicrania continua and Temporomandibular Disorders co-presentation. Case Report.

Cervantes-Chavarria,

Vaglio-Cespedes

2022

Preprint

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Background Hemicrania continua is an uncommon headache disorder that requires complete response to indomethacin for its diagnosis, that becomes on most of the cases chronic pain resilient to treatment. On the other hand, temporomandibular pain is very common on the general population and happens undiagnosed most of the time when headache or migraines are happening at the same time. In this case we aim to highlight the importance of treating all concomitate diagnosis for a better long-term prognosis. Case Presentation: In this paper a case of a 51-year-old male with chronic resilient facial pain is presented. The patient described right sided facial pain with six years of evolution that started with no triggers. The pain was described as constant bilateral pressure being worse on the right side, located on the temples, masseteric and preauricular areas; with an intensity of 6 on a scale of 0 to 10. It is accompanied by episodes of paroxysmal pulsating hemifacial pain with autonomic symptoms (rhinorrhea, conjunctival injections and lacrimation). The pain during exacerbations was located on the right periorbital and hemifacial area and with a intensity of 10 on a scale of 0 to 10, lasting a few minutes to more than 2 hours. After the clinical examination and pain history, the patient was given the diagnosis of hemicrania continua and masticatory myofascial pain. He was started on Indomethacin 25mg twice a day and started on temporomandibular therapy (self-care, jaw exercises, motivation and advice for stress management). Three months after the first evaluation the patient report total resolution of his symptoms. Conclusions The main goal of this article is to highlight that the presence of temporomandibular disorders is common in patients with headaches, for which it is necessary to carry out a comprehensive approach for both entities, which include the therapies for treating axis I diagnosis and behavioral management for axis II this including most of the time with a multidisciplinary human centered approach.

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Hemicrania continua: Case series presenting in an orofacial pain clinic

Abstract: Comorbid pain conditions can be expected in patients with HC presenting to orofacial pain clinics. Symptom presentation varies, and multimodal treatment approach is necessary for success.

Cited by 17 publications

References 26 publications

Trigeminal autonomic cephalalgias presenting in a multidisciplinary tertiary orofacial pain clinic

Trigeminal autonomic cephalalgias presenting in a multidisciplinary tertiary orofacial pain clinic

Treatment of SUNCT/SUNA, Paroxysmal Hemicrania, and Hemicrania Continua: An Update Including Single-Arm Meta-analyses

Hemicrania continua and Temporomandibular Disorders co-presentation. Case Report.

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