Diagnosis Of Hemicrania Continua Research Articles

Hemicrania continua and Temporomandibular Disorders Co-Presentation. Case Report

Hemicrania continua is an uncommon headache disorder that requires complete response to indomethacin for its diagnosis, that becomes on most of the cases chronic pain resilient to treatment. On the other hand, temporomandibular pain is very common on the general population and happens to be undiagnosed most of the time when headache or migraines are happening at the same time. In this case we aim to highlight the importance of treating all concomitant diagnosis for a better long-term prognosis. In this paper, a case of a 51-year-old male with chronic resilient facial pain is presented. The patient described right sided facial pain with six years of evolution that started with no triggers. The pain was described as constant bilateral pressure being worse on the right side, located on the temples, masseteric and preauricular areas; with an intensity of 6 on a scale of 0 to 10. It is accompanied by episodes of paroxysmal pulsating hemifacial pain with autonomic symptoms (rhinorrhea, conjunctival injections and lacrimation). The pain during exacerbations was located on the right periorbital and hemifacial area and with an intensity of 10 on a scale of 0 to 10, lasting a few minutes to more than 2 hours. After the clinical examination and pain history, the patient was given the diagnosis of hemicrania continua and masticatory myofascial pain. He was started on Indomethacin 25mg twice a day and started on temporomandibular therapy (self-care, jaw exercises, motivation and advice for stress management). Three months after the first evaluation the patient reported total resolution of his symptoms. The main goal of this article is to highlight that the presence of temporomandibular disorders is common in patients with headaches, for which it is necessary to carry out a comprehensive approach for both entities, which include the therapies for treating axis I diagnosis and behavioral management for axis II, this including most of the time a multidisciplinary human centered approach.

Treatment of Hemicrania Continua: Case Series and Literature Review

Hemicrania Continua (HC) is a primary, disabling headache characterized by a continuous unilateral pain and responsive to indomethacin. There are symptoms common to the trigeminal-autonomic cephalalgias and migraine that complicate the diagnosis. This review aims to describe HC in a case series and review the best available evidence on alternative therapies. A systematic review of medical records and diaries of pain of 1,600 patients treated between January 1992 and January 2011 in a headache outpatient clinic. Ten patients with a possible diagnosis of hemicrania continua were selected; seven were diagnosed with HC according to the II International Classification of Headache Disorders. None of the patients had received the correct diagnosis before being treated at the outpatient clinic and the average time for treatment was 12 years. Prophylactic treatment was effective in 66.6% of cases with amitriptyline, 20% with gabapentin and 10% with topiramate. HC should be considered among the diagnostic hypotheses of patients with continuous headache, with no change in neurological examination and additional tests, regardless the age of onset. The standard treatment with indomethacin (100-150mg.day(-1)) has significant risks associated with both short and long term use and may not be a good choice for continuous use. Recent studies point out possible alternatives: gabapentin, topiramate, cyclooxygenase-2 inhibitors, piroxicam, beta-cyclodextrin, amitriptyline, melatonin. Other drugs were described in different reports as efficient, but most of them were considered inefficient in other HC cases.

Activation of the Brainstem but not of the Hypothalamus in Hemicrania Continua without Autonomic Symptoms

A 64-year-old woman presented with a 6-month history of right-sided continuous headache, without autonomic symptoms and complete response to indomethacin. Clinical examination and structural brain imaging were normal. A diagnosis of hemicrania continua (HC) was made. We sought to determine the brain structures active during the pain in a patient who met all of the diagnostic criteria for HC with the exception of autonomic symptoms. A brain positron emission tomography study was performed during pain, and completely pain-free after indomethacin administration. Comparing the pain with pain-free states, the region of the dorsal pons was significantly activated. There was no activation in the hypothalamus, as previously reported in HC with autonomic symptoms. Although definitive conclusions can not be drawn from a single observation, the lack of autonomic symptoms along with the absence of hypothalamic activation suggests that the clinical presentation may predict the pattern of brain activation in primary headache syndromes.

Hemicrania Continua Secondary to an Ipsilateral Brainstem Lesion

We describe a 47-year-old woman with a 3-year history of a continuum mild-moderate right-side headache, with exacerbations, associated with stabbing volleys of pain on right orbit-temporal region (10/10) and right eye ptosis and lacrimation with conjunctival injection. The pain was completely abolished with indomethacin (100 mg per day). The diagnosis of hemicrania continua was made according to the International Headache Society (IHS) criteria. The headache presentation was precipitated by a stroke and a right-side brainstem lesion was present at magnetic resonance imaging. This case report shows anatomoclinical evidence of the involvement of brainstem structures on the pathophysiology of hemicrania continua.

Behandlung eines atypischen und therapierefraktären Clusterkopfschmerzes mit Topiramat

Cluster headache is the third most frequent type of primary cephalgia only exceeded in frequency by tension-type headache and migraine. Cluster headache is characterized by periodic attacks of unilateral excruciating pain and accompanying autonomic features. It is arguably the most disabling form of primary headache. Therefore, prompt recognition of this disorder is necessary to provide an opportunity for effective treatment. We report on a patient with cluster headache, who complained about an atypical interval of dull headache between the cluster attacks, thus excluding the differential diagnosis of hemicrania continua. The common drugs for acute cluster attacks proved to be ineffective as well as prophylactic treatment with steroids and verapamil. Only administration of topiramate led to relief of pain.

Hemicrania Continua in a Black Patient the Importance of the Non‐Continuous Stage

A 52-year-old black female for 19 years had severe intermittent unilateral headaches that demonstrated the "clustering" phenomenon. She was initially diagnosed as having episodic cluster headache. Response to lithium carbonate, ergotamine and courses of corticosteroids was, however, only partial. In December 1989 the headache pattern changed and she developed severe unilateral hemicranial headache that was continuous and non-remitting. This responded immediately and persistently to oral indomethacin. A diagnosis of hemicrania continua (HC) was made. The initial intermittent headache syndrome appears to have been the pre-continuous stage of hemicrania continua, and not episodic cluster headache as previously supposed. The pre-continuous phase of hemicrania continua may thus masquerade as episodic cluster headache by reason of its intermittency and "clustering". In this case, the intermittent stage was protracted. This stage may, conceivably, even be a permanent one. To our knowledge, this is the first report of hemicrania continua in a black African.