“Hemicrania Continua”. An Indomethacin Responsive Headache. II. Autonomic Function Studies

Cephalalgia ◽  
1984 ◽  
Vol 4 (4) ◽  
pp. 265-273 ◽  
Author(s):  
O Sjaastad ◽  
ELH Spierings ◽  
C Saunte ◽  
Maria M Wysocka Bakowska ◽  
I Sulg ◽  
...  
Keyword(s):  
Autonomic Function ◽  
Hemicrania Continua ◽  
Paroxysmal Hemicrania ◽  
Unilateral Headache ◽  
Different Types ◽  
Chronic Paroxysmal Hemicrania ◽  
Symptomatic Side

Various autonomic parameters have been studied in two patients with “hemicrania continua”, a newly described unilateral headache which is aborted by indomethacin. Striking findings were made on pupillometry: In both patients, isocoria was present when untreated. Bilateral instillation of tyramine in the conjunctival sac resulted in a late appearing anisocoria, with the smaller pupil on the symptomatic side. Indomethacin medication corrected this anomaly. These findings add further evidence to our firm belief that “hemicrania continua” differs fundamentally from chronic paroxysmal hemicrania, where such pupillometric changes are not found. There thus seem to be at least two different types of hemicranias with an absolute indomethacin effect.

“Hemicrania Continua”: Another Headache Absolutely Responsive to Indomethacin

Cephalalgia ◽  
1984 ◽  
Vol 4 (1) ◽  
pp. 65-70 ◽  
Author(s):  
Ottar Sjaastad ◽  
Egilius LH Spierings
Keyword(s):  
Temporal Pattern ◽  
Cervicogenic Headache ◽  
Hemicrania Continua ◽  
Paroxysmal Hemicrania ◽  
Dependent Effect ◽  
Unilateral Headache ◽  
Chronic Paroxysmal Hemicrania ◽  
Accompanying Symptoms ◽  
Dose Dependent ◽  
Dose Dependent Effect

Two cases suffering from a headache apparently at variance with well recognized headaches are described. It is characterized by a steady, non-paroxysmal, probably severe to moderately severe hemicrania localized anteriorly or anteroposteriorly and is not associated with nausea. Indomethacin exerts an absolute, persistent and clearly dose-dependent effect on this headache, which differs from unilateral headache syndromes such as cluster headache and cervicogenic headache in its temporal pattern and indomethacin response. It differs from chronic paroxysmal hemicrania in its temporal pattern and in the lack of accompanying symptoms.

Dose, Efficacy and Tolerability of Long-Term Indomethacin Treatment of Chronic Paroxysmal Hemicrania and Hemicrania Continua

Cephalalgia ◽  
2001 ◽  
Vol 21 (9) ◽  
pp. 906-910 ◽  
Author(s):  
JA Pareja ◽  
AB Caminero ◽  
E Franco ◽  
JL Casado ◽  
J Pascual ◽  
...  
Keyword(s):  
Hemicrania Continua ◽  
Paroxysmal Hemicrania ◽  
Chronic Paroxysmal Hemicrania ◽  
Indomethacin Treatment

Chronic Paroxysmal Hemicrania. VII. Mechanical Precipitation of Attacks: New Cases and Localization of Trigger Points

Cephalalgia ◽  
1984 ◽  
Vol 4 (2) ◽  
pp. 113-118 ◽  
Author(s):  
Ottar Sjaastad ◽  
Carsten Saunte ◽  
JR Graham
Keyword(s):  
Posterior Part ◽  
Transverse Process ◽  
Trigger Points ◽  
Paroxysmal Hemicrania ◽  
Sensitive Area ◽  
Manual Pressure ◽  
Chronic Paroxysmal Hemicrania ◽  
Local Tenderness ◽  
Symptomatic Side

Two new chronic paroxysmal hemicrania patients are described. In both, attacks can be precipitated mechanically by applying firm manual pressure to certain sensitive points on the neck, i.e. in the C2 area, in the transverse processes of the C4–C5 vertebrae, or beneath the posterior part o15 the skull on the symptomatic side. The most sensitive area seems to be the transverse process of C4–C5. Susceptibility to this type of attack is dependent on the flow of spontaneous attacks; attacks are easily precipitated in a phase with multiple spontaneous attacks, but are not readily precipitated otherwise. Under indomethacin protection, local tenderness is clearly diminished and attacks cannot be precipitated.

Classification, diagnostic criteria, and epidemiology

2020 ◽  
pp. 177-181
Author(s):  
Thijs H. Dirkx ◽  
Peter J. Koehler
Keyword(s):  
Cluster Headache ◽  
Epidemiological Data ◽  
Hemicrania Continua ◽  
Paroxysmal Hemicrania ◽  
Primary Headaches ◽  
Conjunctival Injection ◽  
Headache Disorders ◽  
Cranial Autonomic Symptoms ◽  
Unilateral Headache

The trigeminal autonomic cephalalgias (TACs), including cluster headache, paroxysmal hemicrania, SUNCT (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing), SUNA (with cranial autonomic symptoms), and hemicrania continua, belong to the primary headaches. They are characterized by severe unilateral headache attacks in association with ipsilateral cranial autonomic features. Cluster headache is the most frequent of the TACs. The other TACs are rare, but epidemiological data are scarce and variable. The various types of TAC are distinguished not only by differences in attack frequency and duration, but also by differences with respect to treatment response. The typical headache syndromes, fulfilling the International Classification of Headache Disorders-3 criteria, have also been described in association with other disorders and imaging is required to exclude intracranial pathology in all newly diagnosed patients.

scholarly journals Multiple cranial nerve blocks for the transitional treatment of chronic headaches

Cephalalgia ◽  
2019 ◽  
Vol 39 (12) ◽  
pp. 1488-1499 ◽  
Author(s):  
Sarah Miller ◽  
Susie Lagrata ◽  
Manjit Matharu
Keyword(s):  
Cluster Headache ◽  
Chronic Migraine ◽  
Cranial Nerve ◽  
Chronic Cluster Headache ◽  
Hemicrania Continua ◽  
Paroxysmal Hemicrania ◽  
Nerve Blocks ◽  
Greater Occipital Nerve ◽  
Chronic Paroxysmal Hemicrania ◽  
Multiple Cranial Nerve

Background Multiple cranial nerve blocks of the greater and lesser occipital, supraorbital, supratrochlear and auriculotemporal nerves are widely used in the treatment of primary headaches. We present efficacy and safety data for these procedures. Methods In an uncontrolled open-label prospective study, 119 patients with chronic cluster headache, chronic migraine, short lasting unilateral neuralgiform attack disorders, new daily persistent headaches, hemicrania continua and chronic paroxysmal hemicrania were examined. All had failed to respond to greater occipital nerve blocks. Response was defined as a 50% reduction in either daily attack frequency or moderate-to-severe headache days after 2 weeks. Results The response rate of the whole cohort was 55.4%: Chronic cluster headache, 69.2%; chronic migraine, 49.0%; short lasting unilateral neuralgiform attack disorders, 56.3%; new daily persistent headache, 10.0%; hemicrania continua, 83.3%; and chronic paroxysmal hemicrania, 25.0%. Time to benefit was between 0.50 and 33.58 hours. Benefit was maintained for up to 4 weeks in over half of responders in all groups except chronic migraine and paroxysmal hemicrania. Only minor adverse events were recorded. Conclusion Multiple cranial nerve blocks may provide an efficacious, well tolerated and reproducible transitional treatment for chronic headache disorders when greater occipital nerve blocks have been unsuccessful.

Chronic Paroxysmal Hemicrania. IX. On the Mechanism of Attack-Related Sweating

Cephalalgia ◽  
1983 ◽  
Vol 3 (3) ◽  
pp. 191-199 ◽  
Author(s):  
Carsten Saunte ◽  
David Russell ◽  
Ottar Sjaastad
Keyword(s):  
Body Weight ◽  
Cluster Headache ◽  
Paroxysmal Hemicrania ◽  
Sweat Glands ◽  
Sympathetic Stimulation ◽  
Provocation Tests ◽  
Denervation Supersensitivity ◽  
Chronic Paroxysmal Hemicrania ◽  
Exercise Induced ◽  
Symptomatic Side

In eight patients with chronic paroxysmal hemicrania (CPH), forehead sweating was measured after various provocation tests-body heating, exercise, and subcutaneous pilocarpine administration (0.1 mg/kg body weight). Evaporation was measured bilaterally on the forehead with an Evaporimeter (in g/m2/h). This was carried out in a thermo room under standardized conditions. There was no definite deficit in heat-induced or exercise-induced sweating on the symptomatic side of the forehead, contrary to findings in cluster headache. Neither did pilocarpine lead to any marked initial, temporary predominance of sweating on the symptomatic side, which has previously been found in cluster headache. In cluster headache there may be denervation supersensitivity of the sweat glands in the forehead of the symptomatic side. The present study does not therefore provide evidence for supersensitivity phenomena which could explain the homolateral forehead sweating increase seen during attacks in some CPH patients. The localized sweating increase in the forehead during attacks of CPH may possibly be a result of direct sympathetic stimulation.

The Hemicrania Continua Diagnosis

Cephalalgia ◽  
2001 ◽  
Vol 21 (10) ◽  
pp. 940-946 ◽  
Author(s):  
JA Pareja ◽  
F Antonaci ◽  
M Vincent
Keyword(s):  
Temporal Pattern ◽  
Hemicrania Continua ◽  
Paroxysmal Hemicrania ◽  
Remarkable Feature ◽  
Relative Paucity ◽  
Chronic Paroxysmal Hemicrania ◽  
Daily Headache ◽  
Group 3 ◽  
Clinical Pictures

More than 16 years after the first description of hemicrania continua (HC), its aetiology and pathogenesis remain obscure. Clinically, HC is considered a syndrome with two pivotal characteristics: (i) strictly unilateral (moderate, fluctuating, relatively long-lasting) headache; and (ii) absolute response to indomethacin. HC is further characterized by some ancillary, but mostly ‘negative’, features such as: (iii) relative paucity of accompaniments; and (iv) lack of precipitating factors. The female preponderance is also remarkable, although not diagnostic in the solitary case. Finally, a non-specific, but remarkable feature is the temporal pattern. HC may present as a remitting or chronic (continuous) headache. In HC, unilaterality and absolute response to indomethacin are considered crucial diagnostically. Existing controversy, such as regarding atypical features, particularly the so-called ‘HC resistant to indomethacin’, is discussed. The nature of hemicrania with negative indomethacin response remains most unclear; it may not belong to the HC cycle at all. Accordingly, we propose that the typical clinical picture of HC, including an absolute response to indomethacin, be termed Hemicrania continua vera. More or less analogous, but indomethacin-resistant, clinical pictures can provisionally be termed Hemicrania generis incerti (of undetermined nature), provided other diagnostic possibilities have been ruled out. The differential diagnosis of HC vs. other unilateral headaches is commented on. Previous attempts at classification of HC into the group chronic daily headache (CDH) are discussed. The only acceptable ‘link’ of HC with the other headaches classified as CDH is the temporal pattern (which is a non-specific feature). HC is probably pathophysiologically different from the others disorders classified under CDH. Conversely, HC and chronic paroxysmal hemicrania share many common features, including the absolute response to indomethacin. HC should probably be included in the IHS group 3.

Chronic Paroxysmal Hemicrania: XIII. The Pupillometric Pattern

Cephalalgia ◽  
1988 ◽  
Vol 8 (3) ◽  
pp. 219-226 ◽  
Author(s):  
Deusvenir de Souza Carvalho ◽  
Roll Salvesen ◽  
Trond Sand ◽  
Stephen E Smith ◽  
Ottar Sjaastad
Keyword(s):  
Cluster Headache ◽  
The Body ◽  
Paroxysmal Hemicrania ◽  
Sweat Glands ◽  
Chronic Paroxysmal Hemicrania ◽  
Sweating Patterns ◽  
Symptomatic Side ◽  
Age And Sex ◽  
Headache Patients

Pupillometric studies were carried out in eight patients with chronic paroxysmal hemicrania (CPH) and in age- and sex-matched controls in the basal condition and after instillation of 2% tyramine (CPH, n = 5; controls, n = 17), 1% OH-amphetamine (CPH, n = 6; controls, n = 12), and 1% phenylephrine (CPH, n = 6; controls, n = 17). The pupil on the symptomatic and non-symptomatic sides in CPH patients was significantly smaller in the basal condition than in controls, particularly on the symptomatic side. The mydriatic responses to pharmacologic stimulation were essentially similar on the symptomatic and non-symptomatic sides. An evaporimetric study of the forehead sweat glands, using the body heating and pilocarpine tests, was also carried out in these patients and in age- and sex-matched controls. “Early”, “intermediate”, and “late” measurements demonstrated symmetry of forehead sweating. The findings for both methods of examination thus contrast with those in cluster headache patients. Pupillometric and forehead sweating patterns therefore suggest differences in the pathogenesis of the two headache entities. These tests may be used to distinguish CPH and cluster headache clinically.

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