Indomethacin-Responsive Headaches

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.

Pediatric paroxysmal hemicrania: a case report and some clinical considerations

“…In our case the intensity, frequence and duration of attacks, the cranial autonomic symptoms and the circadian rhythms of attacks are overlapping between two disorders while there are usually reported differences in behavior during attacks and response to indomethacin. However, responsive cluster cases to indomethacin were reported in literature and agitation and restlessness were described in paroxysmal headache cases [2,4]. Further difficulty comes from dramatical positive response to steroids in our patient, similar to efficacy of steroids in cluster headache [4,5].…”

Abstracts from the 58th Annual Scientific Meeting American Headache Society

“…1 The quality of the available information on the internet has been evaluated in multiple disease states. [2][3][4][5][6][7] The information content has not been evaluated for migraine treatments. Online health information can impact the doctor patient relationship.…”

“…3 On the other hand migraine in both children and adults is reported to be comorbid with a number of other comorbid disorders and conditions. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Given the significance of association of puberty with migraine incidence in girls, this study aimed to characterize the prevalence of comorbid disorders in adolescent migraineurs between10 to 15.…”

“…Presence of migraine and other types of headaches were determined according to the guidelines set forth by the International Classification of Headache Disorders (ICHD). 6 Generalized estimating equations were used to examine associations between headaches and age at menarche. Results: Many females had a history of headaches, with approximately equal numbers reporting symptoms consistent with migraine (29.7%) and non-migraine headaches (25.3%).…”

Cluster headache management and beyond

“…This drug is generally not recommended by international guidelines, and should not be used in the presence of arterial hypertension or gastric bleeding [17].…”