Secondary hemicrania continua: Case reports and a literature review

Prakash, Sanjay; Shah, Nilima D.; Soni, Ronak

doi:10.1016/j.jns.2009.01.011

Cited by 33 publications

(36 citation statements)

References 24 publications

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“…Of note, response to indomethacin cannot be used to exclude a secondary cause of HC. To that end, secondary HC may actually have a lower mean dose requirement (143-145 mg) of indomethacin compared to primary HC (176-200 mg) [23].…”

Section: Hemicrania Continuamentioning

confidence: 99%

Indomethacin-Responsive Headaches

VanderPluym

2014

Curr Neurol Neurosci Rep

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Indomethacin-responsive headaches are a heterogeneous group of primary headache disorders distinguished by their swift and often absolute response to indomethacin. The epidemiology of these conditions is incompletely defined. Traditionally, indomethacin-responsive headaches include a subset of trigeminal autonomic cephalalgias (paroxysmal hemicrania and hemicrania continua), Valsalva-induced headaches (cough headache, exercise headache, and sex headache), primary stabbing headache, and hypnic headache. These headache syndromes differ in extent of response to indomethacin, clinical features, and differential diagnoses. Neuroimaging is recommended to investigate for various organic causes that may mimic these headaches. Case reports of other primary headache disorders that also respond to indomethacin, such as cluster headache, nummular headache, and ophthalmoplegic migraine, have been described. These "novel" indomethacin-responsive headaches beg the question of what headache characteristics are required to qualify a headache as an indomethacin-responsive headache. Furthermore, they challenge the concept of using a therapeutic intervention as a diagnostic criterion.

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Section: Hemicrania Continuamentioning

confidence: 99%

Indomethacin-Responsive Headaches

VanderPluym

2014

Curr Neurol Neurosci Rep

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“…Activation of the trigeminal nerve could trigger TAR 11. A number of secondary HC had produced symptoms probably by activating trigeminal nerve 12. Cornea is innervated by ophthalmic division of trigeminal nerve.…”

Section: Discussionmentioning

confidence: 99%

“…Infiltration of chronic inflammatory cells is also reported in the dorsal root and nerve 14. It has been suggested that constant pain arises from a marked loss of nociceptive afferents, whereas paroxysmal pain is related to demyelination 12. Allodynia is explained by central sensitisation.…”

Section: Discussionmentioning

confidence: 99%

Herpes zoster ophthalmicus evolving into headache characterised as hemicrania continua

Prakash¹,

Dave

Joshi

2018

BMJ Case Reports

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Postherpetic neuralgia (PHN) is the most common chronic complication of herpes zoster infection. However, a few patients may develop different types of pain after herpetic lesions. We are reporting two patients who developed postherpetic hemicrania continua (HC). Case 1: a 54-year-old woman had a 10-month history of continuous left-sided pain with superimposed exacerbations. The pain started with the onset of herpetic lesions in the ophthalmic division. The lesions subsided in a few weeks. However, the pain persisted and it responded exclusively to indomethacin. Case 2: a 61-year-old woman developed clinical features pertinent to PHN. However, later on, the pattern and associated clinical features changed. The patient fulfilled the criteria of HC and showed a complete response to indomethacin. We suggest that every patient with PHN should be asked for cranial autonomic features and a trial of indomethacin should be given in refractory herpes zoster neuropathy.

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“…Therefore, a detailed history, investigations and appropriate investigation are a must in such patients (for details, the readers are encouraged to see a review on this topic) 42. Once secondary causes are ruled out, we can diagnose primary TACs.…”

Section: Diagnosismentioning

confidence: 99%

Hemicrania continua: clinical review, diagnosis and management

Prakash¹,

Patel

2017

JPR

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Hemicrania continua (HC) is an indomethacin-responsive primary headache disorder which is currently classified under the heading of trigeminal autonomic cephalalgias (TACs). It is a highly misdiagnosed and underreported primary headache. The pooled mean delay of diagnosis of HC is 8.0 ± 7.2 years. It is not rare. We noted more than 1000 cases in the literature. It represents 1.7% of total headache patients attending headache or neurology clinic. Just like other TACs, it is characterized by strictly unilateral pain in the trigeminal distribution, cranial autonomic features in the same area and agitation during exacerbations/attacks. It is different from other TACs in one aspect. While all other TACs are episodic, HC patients have continuous headaches with superimposed severe exacerbations. The central feature of HC is continuous background headache. However, the patients may be worried only for superimposed exacerbations. Focusing only on exacerbations and ignoring continuous background headache are the most important factors for the misdiagnosis of HC. A large number of patients may have migrainous features during exacerbation phase. Up to 70% patients may fulfill the diagnostic criteria for migraine during exacerbations. Besides migraine, its exacerbations can mimic a large number of other primary and secondary headaches. The other specific feature of HC is a remarkable response to indomethacin. However, a large number of patients develop side effects because of the long-term use of indomethacin. A few other medications may also be effective in a subset of patients with HC. Various surgical interventions have been suggested for patients who are intolerant to indomethacin. Several aspects of HC are still not defined. There is a great heterogeneity in types of patients or articles on the HC in the literature. Diagnostic criteria have been modified several times over the years. The current diagnostic criteria are too restrictive in some aspects. We suggest a more accommodating type of criteria for the appendix of International Classification of Headache Disorder (ICHD).

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Secondary hemicrania continua: Case reports and a literature review

Cited by 33 publications

References 24 publications

Indomethacin-Responsive Headaches

Indomethacin-Responsive Headaches

Herpes zoster ophthalmicus evolving into headache characterised as hemicrania continua

Hemicrania continua: clinical review, diagnosis and management

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