Coexistence of cluster headache and paroxysmal hemicrania: does it exist? A case report and literature review

The "velocity" of publications on IMC and headache seems to be decreasing, particularly on the use of IMC for the treatment of TACs. The science behind the understanding of the putative mechanisms of IMC's action on headache has moved forward, but the answer to why it works better than other nonsteroidal anti-inflammatory drugs has been elusive. There are case reports of other rare headache disorders that may be responsive to IMC. The dosages of IMC used as a tool for detecting IMC responsive disorders vary according to different centers of investigation. In many circumstances, headache disorders similar to "primary" IMC-responsive disorders are actually symptomatic disorders. Cluster headache as an IMC-resistant headache disorder may not be as absolute as once thought. Sometimes, IMC has been found to provoke headache; differentiating IMC-provoked headache from IMC-resistant headache can make headache diagnosis and management difficult. As for the "absolute" responsiveness of IMC, it is possible that using higher dosages leads to higher sensitivity, probably at the expense of decreased specificity. There are many reports about the occurrence of two or more IMC-responsive disorders (latu sensu) in the same patient, which may be coincidental.

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“…The shorter duration attacks and the longer duration attacks subsided completely at the doses of 50 mg t.i.d. and 100 mg t.i.d., respectively …”

Section: The Morphing Tacsmentioning

confidence: 98%

Indomethacin Responsive Headaches: Exhaustive Systematic Review With Pooled Analysis and Critical Appraisal of 81 Published Clinical Studies

Bordini

Bordini²,

Woldeamanuel

et al. 2016

Headache

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“…Die paroxysmale Hemikranie muss in erster Linie F einerseits vom Clusterkopfschmerz und F andererseits von der Trigeminusneuralgie abgegrenzt werden [13]. Bei Kenntnis der diagnostischen Kriterien und des neurologischen Befunds können diese 3 Kopfschmerzentitäten sicher differenziert werden [2,3,5,11,15,18].…”

Section: Differenzialdiagnoseunclassified

Paroxysmale Hemikranie und SUNCT

Göbel

Heinze

2011

Schmerz

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Paroxysmal hemicrania is experienced as headache attacks with pain and accompanying symptoms similar to those of cluster headaches. Attacks are, however of shorter duration, occur more frequently, affect predominantly women and respond reliably to indomethacin. Paroxysmal hemicrania can also occur secondary to an identifiable cause. To exclude symptomatic, paroxysmal hemicrania, especially with an atypical clinical picture and poor response to indomethacin, a careful diagnostic approach is necessary. The SUNCT syndrome (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing) is characterized by one-sided pain attacks of short duration, much shorter than other trigeminal autonomic cephalgias. Classically, the pain is accompanied by ipsilateral lacrimation and conjunctival injection. Some patients have been described with both cluster headache and trigeminal neuralgia. These patients should receive both diagnoses. It is important to differentiate these headache entities as specific therapy is needed for each to achieve optimal pain relief.

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“…However, in the literature we noted at least 2 more cases 8,9 . In the same way, the authors failed to review a case presenting with both CH and HC 10 . In that article Shah and Prakash reported a 22‐year‐old man who had CH and PH since the onset of symptoms.…”

mentioning

confidence: 99%

Coexisting Trigeminal Autonomic Cephalalgias and Hemicrania Continua

Prakash¹,

Lakhani²

2010

Headache

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REFERENCES1. Ashkenazi A, Blumenfeld A, Napchan U, et al. Peripheral nerve blocks and trigger point injections in headache management -A systematic review and suggestions for future research. Headache. 2010;50:943-952. 2. Weatherall MW. Idiopathic trigeminal neuropathy may respond to greater occipital nerve injection. Cephalalgia. 2008;28:664-666. 3. Evans RW. Greater occipital neuralgia can cause facial paraesthesias. Cephalalgia. 2009;29:801. 4. Han KR, Kim C, Chae YJ, Kim DW. Efficacy and safety of high concentration lidocaine for trigeminal nerve block in patients with trigeminal neuralgia. Int J Clin Pract.We thank Dr. Evans for his comment and interest in our review. We agree that there are currently insufficient data to support the use of greater occipital nerve (GON) block in the treatment of trigeminal neuralgia (TN) or of idiopathic trigeminal neuropathy. Until more data are available, attempting to relieve the pain associated with these conditions using trigeminal nerve blocks appears to be a more reasonable approach. It should be noted, however, that there is compelling evidence from both animal and human studies for functional connectivity between the greater occipital nerve and the trigeminal system. 1,2 These data, together with some evidence for efficacy of GON block in other trigeminally driven headaches (eg, migraine), raise the question of whether GON block may also be effective in the treatment of TN. This hypothesis needs to be addressed in future well-designed controlled studies. In these future studies, patients who have idiopathic TN and those who have secondary TN should preferably be evaluated separately, since the responses of these two groups to GON block may differ. We would expect patients with an underlying structural lesion to do less well than those who have idiopathic TN.

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Coexistence of cluster headache and paroxysmal hemicrania: does it exist? A case report and literature review

Cited by 14 publications

References 18 publications

Indomethacin Responsive Headaches: Exhaustive Systematic Review With Pooled Analysis and Critical Appraisal of 81 Published Clinical Studies

Indomethacin Responsive Headaches: Exhaustive Systematic Review With Pooled Analysis and Critical Appraisal of 81 Published Clinical Studies

Paroxysmale Hemikranie und SUNCT

Coexisting Trigeminal Autonomic Cephalalgias and Hemicrania Continua

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