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

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.

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“Hemicrania Continua”: Another Headache Absolutely Responsive to Indomethacin

Cephalalgia ◽

10.1046/j.1468-2982.1984.0401065.x ◽

1984 ◽

Vol 4 (1) ◽

pp. 65-70 ◽

Cited By ~ 185

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.

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Chronic paroxysmal hemicrania and hemicrania continua responding to topiramate: Two case reports

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2007.09.002 ◽

2008 ◽

Vol 110 (1) ◽

pp. 88-91 ◽

Cited By ~ 39

Author(s):

Cecilia Camarda ◽

Rosolino Camarda ◽

Roberto Monastero

Keyword(s):

Case Reports ◽

Hemicrania Continua ◽

Paroxysmal Hemicrania ◽

Chronic Paroxysmal Hemicrania

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The Hemicrania Continua Diagnosis

Cephalalgia ◽

10.1046/j.1468-2982.2001.00290.x ◽

2001 ◽

Vol 21 (10) ◽

pp. 940-946 ◽

Cited By ~ 44

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.

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

Cephalalgia ◽

10.1046/j.1468-2982.1984.0404265.x ◽

1984 ◽

Vol 4 (4) ◽

pp. 265-273 ◽

Cited By ~ 12

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.

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