Hemicrania Continua: a Clinical Perspective on Diagnosis and Management

Mehta, Amit; Chilakamarri, Priyanka; Zubair, Adeel S.; Kuruvilla, Deena

doi:10.1007/s11910-018-0899-2

Cited by 6 publications

(8 citation statements)

References 51 publications

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“…Indomethacin is currently considered a first-line drug for inducing the closure of the ductus arteriosus in preterm infants, with an acceptable safety profile (Marconi et al, 2019). Also, indomethacin was markedly effective in other clinical settings, such as against renal pain (Pathan et al, 2018) and some types of headache (e.g., hemicrania continua) (Mehta et al, 2018). However, there are few reports indicating its effect in human cancers.…”

Section: Discussionmentioning

confidence: 99%

Searching for Drug Synergy Against Cancer Through Polyamine Metabolism Impairment: Insight Into the Metabolic Effect of Indomethacin on Lung Cancer Cells

et al. 2020

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Non-small cell lung cancer (NSCLC) is the most lethal and prevalent type of lung cancer. In almost all types of cancer, the levels of polyamines (putrescine, spermidine, and spermine) are increased, playing a pivotal role in tumor proliferation. Indomethacin, a non-steroidal anti-inflammatory drug, increases the abundance of an enzyme termed spermidine/ spermine-N 1-acetyltransferase (SSAT) encoded by the SAT1 gene. This enzyme is a key player in the export of polyamines from the cell. The aim of this study was to compare the effect of indomethacin on two NSCLC cell lines, and their combinatory potential with polyamine-inhibitor drugs in NSCLC cell lines. A549 and H1299 NSCLC cells were exposed to indomethacin and evaluations included SAT1 expression, SSAT levels, and the metabolic status of cells. Moreover, the difference in polyamine synthesis enzymes among these cell lines as well as the synergistic effect of indomethacin and chemical inhibitors of the polyamine pathway enzymes on cell viability were investigated. Indomethacin increased the expression of SAT1 and levels of SSAT in both cell lines. In A549 cells, it significantly reduced the levels of putrescine and spermidine. However, in H1299 cells, the impact of treatment on the polyamine pathway was insignificant. Also, the metabolic features upstream of the polyamine pathway (i.e., ornithine and methionine) were increased. In A549 cells, the increase of ornithine correlated with the increase of several metabolites involved in the urea cycle. Evaluation of the levels of the polyamine synthesis enzymes showed that ornithine decarboxylase is increased in A549 cells, whereas S-adenosylmethionine-decarboxylase and polyamine oxidase are increased in H1299 cells. This observation correlated with relative resistance to polyamine synthesis inhibitors eflornithine and SAM486 (inhibitors of ornithine decarboxylase and S-adenosyl-L-methionine decarboxylase, respectively), and MDL72527 (inhibitor of polyamine oxidase and spermine oxidase). Finally, indomethacin demonstrated a synergistic effect with MDL72527 in A549 cells and SAM486 in H1299 cells. Collectively, these results

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Section: Discussionmentioning

confidence: 99%

Searching for Drug Synergy Against Cancer Through Polyamine Metabolism Impairment: Insight Into the Metabolic Effect of Indomethacin on Lung Cancer Cells

et al. 2020

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“…HC is a TAC characterized by unilateral persistent headache and exacerbations with cranial autonomic phenomena, and is responsive to indomethacin 1,2 . HC is a highly misdiagnosed primary headache, and a delay in diagnosis leads to unnecessary severe headache and therapeutic intervention 2 . There are several possible reasons for the high rate of misdiagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…There are several possible reasons for the high rate of misdiagnosis. First, although the main feature of HC is strictly unilateral persistent background headache and superimposed exacerbations, the background headache is likely to be ignored because patients focus on the exacerbations 2 . A second possible reason is that HC often has migrainous features during exacerbations 2 .…”

Section: Discussionmentioning

confidence: 99%

“…First, although the main feature of HC is strictly unilateral persistent background headache and superimposed exacerbations, the background headache is likely to be ignored because patients focus on the exacerbations 2 . A second possible reason is that HC often has migrainous features during exacerbations 2 . Finally, HC may not be considered as a potential diagnosis because it is perceived to be a rare disorder.…”

Section: Discussionmentioning

confidence: 99%

“…Hemicrania continua (HC) is a primary headache disorder that is classified as a trigeminal autonomic cephalalgia (TAC) in the International Classification of Headache Disorders 3rd Edition (ICHD‐3) 1 . HC is usually an idiopathic condition and has been observed in association with another primary headache 2 …”

Section: Introductionmentioning

confidence: 99%

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A case of hemicrania continua‐tic syndrome

Goto

Iwamoto

Yamamoto

et al. 2020

Neurology & Clinical Neurosc

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We report a case of hemicrania continua (HC) accompanied by trigeminal neuralgia (TN). A 35-year-old female diagnosed with HC and TN. The patient had 3 different types of headaches: persistent background headache, severe exacerbations, and shock-like short-lasting headaches. It was considered that the first and second headaches are symptoms of HC, and the last is symptom of TN. The patient responded to indomethacin with complete relief of HC, but not TN. The correct diagnosis of the two headaches is important as both headaches require separate treatments.

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Management of Trigeminal Autonomic Cephalalgias Including Chronic Cluster

2023

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ImportanceTrigeminal autonomic cephalalgias (TACs) comprise a unique collection of primary headache disorders characterized by moderate or severe unilateral pain, localized in in the area of distribution of the first branch of the trigeminal nerve, accompanied by cranial autonomic symptoms and signs. Most TACs are rare diseases, which hampers the possibility of performing randomized clinical trials and large studies. Therefore, knowledge of treatment efficacy must be based only on observational studies, rare disease registries, and case reports, where real-world data and evidence play an important role in health care decisions.ObservationsChronic cluster headache is the most common of these disorders, and the literature offers some evidence from randomized clinical trials to support the use of pharmacologic and neurostimulation treatments. Galcanezumab, a monoclonal antibody targeting the calcitonin gene-related peptide, was not effective at 3 months in a randomized clinical trial but showed efficacy at 12 months in a large case series. For the other TACs (ie, paroxysmal hemicrania, hemicrania continua, short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing, and short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms), only case reports and case series are available to guide physicians in everyday management.Conclusions and RelevanceThe accumulation of epidemiologic, pathophysiologic, natural history knowledge, and data from case series and small controlled trials, especially over the past 20 years from investigators around the world, has added to the previously limited evidence and has helped advance and inform the treatment approach to rare TACs, which can be extremely challenging for clinicians.

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Hemicrania Continua: a Clinical Perspective on Diagnosis and Management

Cited by 6 publications

References 51 publications

Searching for Drug Synergy Against Cancer Through Polyamine Metabolism Impairment: Insight Into the Metabolic Effect of Indomethacin on Lung Cancer Cells

Searching for Drug Synergy Against Cancer Through Polyamine Metabolism Impairment: Insight Into the Metabolic Effect of Indomethacin on Lung Cancer Cells

A case of hemicrania continua‐tic syndrome

Management of Trigeminal Autonomic Cephalalgias Including Chronic Cluster

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