Hemicrania Continua‐Like Headache Related to Transdermal Nitroglycerine Therapy

Mainardi, Federico; Zanchin, Giorgio; Maggioni, Ferdinando

doi:10.1111/head.13004

Cited by 5 publications

(4 citation statements)

References 10 publications

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“…We reviewed PubMed and EMBASE from 1993 to 2021 and found 46 cases based on our search criteria. We excluded six cases that were suitable for our search criteria but were not treated with, or were unresponsive to, indomethacin 6,16–18 . We also excluded one case secondary to trauma because the patient's history was atypical, and there was no mention of baseline headache and autonomic features 19 …”

Section: Resultsmentioning

confidence: 99%

“…We excluded six cases that were suitable for our search criteria but were not treated with, or were unresponsive to, indomethacin. 6,[16][17][18] We also excluded one case secondary to trauma because the patient's history was atypical, and there was no mention of baseline headache and autonomic features. 19 We include an overview of the review process in the flow chart in Figure 1.…”

Section: Re Sultsmentioning

confidence: 99%

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The critical role of neuroimaging in hemicrania continua: A systematic review and case series

Yildiz Goksel,

Bilgin,

Digre

et al. 2024

Headache

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BackgroundHemicrania continua is a primary unilateral headache characterized by ipsilateral parasympathetic and sympathetic autonomic features. A key diagnostic criterion is its dramatic response to indomethacin treatment; however, various vascular or structural abnormalities have been reported to cause secondary hemicrania continua, presenting with clinical features similar to those of the primary headache presentation.ObjectiveWe reviewed the literature to compile secondary hemicrania continua cases, highlighting the importance of imaging during the evaluation. Additionally, we also contributed our three cases to the existing studies.MethodsWe conducted a review of articles from the PubMed and EMBASE databases that described reported cases of secondary hemicrania continua, covering the period from 1993 to 2021. Our review included detailed patient information, signs, and symptoms of hemicrania continua, as well as information on indomethacin usage and headache resolution (if pertinent).ResultsSecondary hemicrania continua can result from a remarkably diverse range of structural and vascular lesions, yet clinical reports on long‐term follow‐up are lacking. Notably, cases may exhibit a classical response to indomethacin, emphasizing the importance of neuroimaging in excluding secondary cases. Our search yielded 41 cases meeting our criteria. We excluded six cases that were not treated with indomethacin or were unresponsive to it. Additionally, we present three cases that highlight the necessity of neuroimaging in evaluating hemicrania continua, along with short‐ and long‐term clinical outcomes following indomethacin and lesion‐directed treatments. Case 1 presented with daily right‐sided headaches and cranial autonomic symptoms. Her pain completely resolved with indomethacin use. Neuroimaging of the brain revealed a laterally directed saccular aneurysm of the right internal carotid artery. Case 2 presented with continuous left‐sided unilateral headaches with superimposed exacerbations. She complained of left‐sided photophobia with a dull sensation in the left ear. Her symptoms decreased after 2 weeks of indomethacin use. Neuroimaging of the head indicated a benign tumor with mass effect into the left lateral medulla and inferior cerebellar peduncle. Case 3 presented with a right side‐locked headache with daily, severe superimposed exacerbations. She had photophobia in the right eye and a right‐sided Horner's syndrome, along with tearing during her exacerbations. Neuroimaging of the brain revealed a pituitary tumor and her pain completely resolved with indomethacin.ConclusionHemicrania continua is a rare headache disorder that can be either primary or secondary. Importantly, response to indomethacin can still occur in secondary hemicrania continua. Thus, neuroimaging should be considered to rule out underlying structural etiology in all cases, regardless of their clinical responsiveness to indomethacin therapy.

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Section: Resultsmentioning

confidence: 99%

Section: Re Sultsmentioning

confidence: 99%

The critical role of neuroimaging in hemicrania continua: A systematic review and case series

Yildiz Goksel,

Bilgin,

Digre

et al. 2024

Headache

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“…Mainardi et al . [ 36 ] described a case of 66-year-old man, with a history of migraine who developed a new headache for 4 months. It was dull, mild frontoparietal headache with several severe exacerbations daily, lasting 45–60 min, accompanied by ipsilateral lacrimation, ptosis, and nose stuffiness; onset of headaches had temporal relationship with transdermal nitroglycerine patch (TNP), recommended for coronary heart disease (unstable angina).…”

Section: N Ew C Ases Of S mentioning

confidence: 99%

Secondary (Symptomatic) trigeminal autonomic cephalalgia

Chowdhury¹

2018

Ann Indian Acad Neurol

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Primary trigeminal autonomic cephalalgias (TACs) are uncommon group of headache disorders. These are defined and diagnosed by the criteria given by the International Classification of Headache Disorders 3β version. Over the past few decades, a number of secondary (symptomatic) cases have been described in the literature with headache features indistinguishable from primary TACs. Many structural and other pathologies have been found in these patients that can be causally related to the headaches. This review attempts to critically analyze the existing literature including the new cases published during 2015–2017.

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“…The literature suggests that patients consult four or more physicians, including neurologists (3,5), over an average time of 8 years (range 1.3–21 years) to derive a diagnosis of HC (2). Misdiagnosis and inappropriate treatment have been attributed to the rarity of HC, as well as paucity of autonomic symptoms, medication overuse, clinical similarities with migraine, half-sided tension-type and cluster headaches, and dental or atypical facial pain (3,5–10). Moreover, HC may co-exist with other primary headache disorders (2), trigeminal neuralgia (11), or temporomandibular disorder (TMD) (12,13).…”

Section: Introductionmentioning

confidence: 99%