Hemicrania Continua with Contralateral Episodic Cluster Headache: A Case Report

Abstract

The trigeminal autonomic cephalgias (TACs) are characterized by short-lasting unilateral headaches with autonomic features (1). They include four headache disorders, cluster headache (CH), paroxysmal hemicrania (PH), SUNCT syndrome and hemicrania continua (HC). The coexistence of different ipsilateral TACs in the same patient has been previously reported in six published cases (2-6). In five of these patients an association of CH and PH was noted (2-5). The two varieties of attacks occurred separately in three patients, while their simultaneous occurrence was observed in two cases. In another patient the successive occurrence of trigeminal neuralgia, SUNCT syndrome, PH and CH in one active headache period was noted (6). All the reported cases concerned male patients. We describe what we believe to be the first case of coexistence of two different contralateral TACs.

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

“…There are reports from Centonze et al and Lisotto et al of similar cases of co‐existing typical episodic CH and HC, including their respective responses to verapamil and IMC.…”

Verapamil-Responsive Hemicrania Continua in a Patient with Episodic Cluster Headache

“…In the Lisotto et al. (4) case patient with probable verapamil‐responsive cluster headache there was complete response of the HC to indomethacin but not to verapamil, although the verpamil dose was never pushed above 360 mg/day. Of note, this patient was started on verapamil for cluster headache and 1 week later his headaches ceased, questioning if this was truly verapamil‐responsive cluster headache or just the natural end of a cycle.…”

“…Activation was noted in the contralateral posterior hypothalamus and ipsilateral dorsal rostral pons in seven patients with indomethacin‐sensitive HC. In several recent case reports HC has been observed to occur in patients with a concomitant history of migraine (3) or cluster headache (4). As both the hypothalamus (possible cluster headache generator) and pons (possible migraine generator or modulator) are activated in HC, it would seem likely that we should be seeing more of these dual headache presentations.…”

Hyper insulinemia in an hemicrania continua patient with sexual headache: Hypothesizing the basis for this unusual association

“…[2] Subsequently cases of HC in association with other primary headache disorders have been reported [ Table 1]. [2][3][4][5][6][7][8][9] In most of these cases, HC evolved from another primary headache disorder. There are only two case reports in whom HC and another primary headache disorder occurred concurrently, similar to our patient.…”

“…There are only two case reports in whom HC and another primary headache disorder occurred concurrently, similar to our patient. [3,4] Migraine and benign exertional headache are the two most common headache disorders associated with HSA. A few reports described HSA in association with another primary headache disorder: HSA in association with CH [10] and HSA in association with hypnic headache.…”