Hemicrania continua in a headache clinic: referral source and diagnostic delay in a series of 22 patients

Abstract

Hemicrania continua (HC) is a unilateral and continuous primary headache with superimposed exacerbations frequently associated with autonomic features. Diagnostic criteria of HC, according to II Edition of International Classification of Headache Disorders require complete response to indomethacin. HC is probably misdiagnosed more often than other primary headaches. We aim to analyze characteristics of a series of 22 consecutive cases of HC. We recruited patients from a headache outpatient clinic in a tertiary hospital over a 3-year period (January 2008 to January 2011). We prospectively gathered demographic and nosological characteristics and considered referral source and delay between onset of headache and diagnosis of HC. Twenty-two patients (14 females, 8 males) out of 1,150, who attended the mentioned clinic during the inclusion period (1.9 %) were diagnosed with HC. All cases responded to indomethacin. No patient received a diagnosis of HC before attending our headache office. Mean latency of diagnosis was 86.1 ± 106.5 months (range 3–360). 11 patients (50 %) were referred from primary care, with 9 (40.9 %) from other neurology clinics and 2 (9.1 %) from other specialities offices. According to our series, HC is not an infrequent diagnosis in a headache outpatient clinic. Diagnostic delay is comparable to data collected in previous studies. As HC is frequently misdiagnosed, we thing there is a need for increasing the understanding of this entity, potentially responsive to indomethacin.

Diagnostic and therapeutic errors in trigeminal autonomic cephalalgias and hemicrania continua: a systematic review

“…Seven CH patients were observed, 6 of whom were un-aware of the diagnosis [19]. Apart from one clinical series of 33 CH patients [9] and two made up of 25 and 22 HC patients, respectively [10,15], the remaining articles were reports of single cases or small numbers of patients with TACs or HC misdiagnosed as other conditions. Data on non-optimal treatment prescribed, even after a correct diagnosis had been established, was available only for CH.…”

Prevalence and clinical features of hemicrania continua in clinic-based studies: A systematic review and meta-analysis

“…Six studies had a prospective design (17)(18)(19)(20)(21)(22) while the remaining five were retrospective cohort studies (2,15,16,23,24). Of the 11 included studies, eight reported on the relative frequency of hemicrania continua in adults (2,(15)(16)(17)(18)(19)(20)(21), and four reported on the relative frequencies of individual clinical features (17,(22)(23)(24). Based on the quality assessment of all included studies, it was deemed that study quality was high in four (15,18,21,22) studies, moderate in five (2,16,17,23,24), and low in two (19,20).…”

“…The literature search identified 957 citations, of which 946 were excluded based on the title and abstract screening (Figure 1). Eleven clinic-based studies were retrieved for further review and met the eligibility criteria for inclusion (2,(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). All included data originated from the outpatient clinic of tertiary care centers.…”

Trigeminal autonomic cephalalgias presenting in a multidisciplinary tertiary orofacial pain clinic

“…Most recently, a systematic review of diagnostic and therapeutic errors in TACs performed by Viana and colleagues [16] showed that patients with CH were found to be the largest category of mismanaged patients. Few case series included mismanagement of HC [17, 18]. Rossi and colleagues described 25 patients fulfilling the ICHD-II criteria for HC among 1612 subjects attending an Italian Headache Centre over a three-year period [18].…”