Treatment of Hemicrania Continua: Case Series and Literature Review

Moura, Lidia M.V.R.; Bezerra, José Marcelo Ferreira; Fleming, Norma Regina Pereira

doi:10.1016/s0034-7094(12)70116-2

Cited by 15 publications

(9 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A very recent abstract stated that melatonin was ineffective in HC patients who needed to discontinue indomethacin secondary to side effects, but the number of patients treated with melatonin was not mentioned, nor was the dosing utilized . Most other recent studies of HC do not even mention melatonin when documenting alternative prophylactic treatments used in treating patients . Based on this present retrospective analysis of clinic‐based patients with ICHD 3‐beta‐defined HC, only a small percent of subjects (less than 20%) will achieve pain freedom on melatonin, thus clearly not matching the effectiveness of indomethacin.…”

Section: Discussionmentioning

confidence: 76%

“…Melatonin, a neuro‐hormone with a chemical structure similar to indomethacin, has been shown to be effective as a preventive treatment in several case reports of HC . Other agents such as topiramate, gabapentin, amitriptyline, methysergide, and COX‐2 inhibitors have also shown some efficacy in HC, again in case series or isolated case reports, but melatonin is an extra attractive alternative therapy as it presents a treatment with minimal side effect profile for a chronic disease state that may require lifelong therapy . The question is how truly effective is melatonin for HC and what doses are required for a preventive effect.…”

mentioning

confidence: 99%

See 1 more Smart Citation

How Effective Is Melatonin as a Preventive Treatment for Hemicrania Continua? A Clinic‐Based Study

Rozen

2015

Headache

View full text Add to dashboard Cite

From this single clinic investigation, only a small percent of subjects with hemicrania continua (less than 20%) will achieve pain freedom on melatonin, thus clearly not matching the effectiveness of indomethacin. However, the addition of melatonin to indomethacin may allow around 45% of patients to have complete or partial relief of their headache with the subsequent ability to reduce or eliminate their indomethacin dosage, which may lead to a decrease in medical morbidity over time secondary to less exposure to indomethacin.

show abstract

Section: Discussionmentioning

confidence: 76%

mentioning

confidence: 99%

How Effective Is Melatonin as a Preventive Treatment for Hemicrania Continua? A Clinic‐Based Study

Rozen

2015

Headache

View full text Add to dashboard Cite

show abstract

“…Tearing was the most common cranial autonomic feature (36%–77%) in all reported case series 7,11,14,25,28,29. Conjunctival injection, ptosis, nasal congestion and rhinorrhea are other common CAS in patients with HC.…”

Section: Clinical Featuresmentioning

confidence: 86%

“…This prevalence is slightly lower than the prevalence of CAS in CH and PH patients, where it is noted in more than 90% cases. However, a few case series of HC have also reported CAS in more than 90% cases 7,11,14,28. Variability in the prevalence of CAS may be because of the selection bias in the particular series, as the importance of CAS for the diagnostic purpose has repeatedly been changed over the time.…”

Section: Clinical Featuresmentioning

confidence: 99%

Hemicrania continua: clinical review, diagnosis and management

Prakash¹,

Patel

2017

JPR

View full text Add to dashboard Cite

Hemicrania continua (HC) is an indomethacin-responsive primary headache disorder which is currently classified under the heading of trigeminal autonomic cephalalgias (TACs). It is a highly misdiagnosed and underreported primary headache. The pooled mean delay of diagnosis of HC is 8.0 ± 7.2 years. It is not rare. We noted more than 1000 cases in the literature. It represents 1.7% of total headache patients attending headache or neurology clinic. Just like other TACs, it is characterized by strictly unilateral pain in the trigeminal distribution, cranial autonomic features in the same area and agitation during exacerbations/attacks. It is different from other TACs in one aspect. While all other TACs are episodic, HC patients have continuous headaches with superimposed severe exacerbations. The central feature of HC is continuous background headache. However, the patients may be worried only for superimposed exacerbations. Focusing only on exacerbations and ignoring continuous background headache are the most important factors for the misdiagnosis of HC. A large number of patients may have migrainous features during exacerbation phase. Up to 70% patients may fulfill the diagnostic criteria for migraine during exacerbations. Besides migraine, its exacerbations can mimic a large number of other primary and secondary headaches. The other specific feature of HC is a remarkable response to indomethacin. However, a large number of patients develop side effects because of the long-term use of indomethacin. A few other medications may also be effective in a subset of patients with HC. Various surgical interventions have been suggested for patients who are intolerant to indomethacin. Several aspects of HC are still not defined. There is a great heterogeneity in types of patients or articles on the HC in the literature. Diagnostic criteria have been modified several times over the years. The current diagnostic criteria are too restrictive in some aspects. We suggest a more accommodating type of criteria for the appendix of International Classification of Headache Disorder (ICHD).

show abstract

“…Once again, the evidence is limited to case reports, but oral drugs that may prove useful include COX-2 inhibitors (Rofecoxib and Celecoxib) [51, 52], melatonin [53–55], topiramate [44, 56–58], verapamil [59, 60], and gabapentin [58, 61, 62]. …”

Section: Hcmentioning

confidence: 99%

Trigeminal Autonomic Cephalalgias: Beyond the Conventional Treatments

Miller

Matharu

2014

Curr Pain Headache Rep

View full text Add to dashboard Cite

The trigeminal autonomic cephalalgias include cluster headache, paroxysmal hemicrania, short-lasting unilateral neuralgiform headache attacks, and hemicrania continua. While the majority responds to conventional pharmacological treatments, a small but significant proportion of patients are intractable to these treatments. In these cases, alternative choices for these patients include oral and injectable drugs, lesional or resectional surgery, and neurostimulation. The evidence base for conventional treatments is limited, and the evidence for those used beyond convention is more so. At present, the most evidence exists for nerve blocks, deep brain stimulation, occipital nerve stimulation, sphenopalatine ganglion stimulation in chronic cluster headache, and microvascular decompression of the trigeminal nerve in short-lasting unilateral neuralgiform headache attacks.

show abstract

Treatment of Hemicrania Continua: Case Series and Literature Review

Cited by 15 publications

References 45 publications

How Effective Is Melatonin as a Preventive Treatment for Hemicrania Continua? A Clinic‐Based Study

How Effective Is Melatonin as a Preventive Treatment for Hemicrania Continua? A Clinic‐Based Study

Hemicrania continua: clinical review, diagnosis and management

Trigeminal Autonomic Cephalalgias: Beyond the Conventional Treatments

Contact Info

Product

Resources

About