Strictly Unilateral Headache Reminiscent of Hemicrania Continua Resistant To Indomethacin But Responsive To Gabapentin

Is there need to search for alternatives to indomethacin for hemicrania continua? Case reports and a review

“…We found at least 31 patients in the literature who showed complete and persistent effects by drugs other than indomethacin-cyclooxygenase-2 inhibitors, topiramate, piroxicam, melatonin, acetyl salicilic acid, ibuprofen, verapamil, and gabapentine (Table 1). Beside this, there are many case reports where above mentioned drugs and few other drugs (such as lamotrigine, methysegide, lithium carbonate, naproxen, paracetamol with caffeine) provided significant (although incomplete and/or transient) effect on the patients of HC [2,[6][7][8][9][10][15][16][17][18][19][20][21][22][23][24][25][26]. This observation is important.…”

Is gabapentin an effective treatment choice for hemicrania continua?

“…That patient had complete pain relief after 17 years of continuous headache. [6]. There have also been two separate reports of melatonin being efficacious for HC, one case reported by Spears [14], and three cases by Rozen [15].…”

“…Marinano da Silva, Alcantara, Bordini, and Speciali reported a case of a unilateral headache similar to HC that was responsive to gabapentin [6]. …”

Hemicrania continua unresponsive or partially responsive to indomethacin: does it exist? A diagnostic and therapeutic dilemma

“…A complete and persistent response to indomethacin was included as a pre-requisite criterion for the diagnosis of HC by the classification criteria of the IHS in 2004 [1]. Many cases (at least 13) have been reported (before 2004), where typical cases of HC did not respond to indomethacin [14–18]. Kuritzky [15] reported four patients who otherwise met clinical criteria for HC yet failed to respond to treatment with indomethacin.…”

“…Wheeler [16] reported six patients of HC who did not show response to indomethacin. Besides these, there are many other cases, where response to indomethacin was not complete or sustained [17, 18]. However, there is no case report of indomethacin-resistant HC (or HC like headache) in the literature after 2004.…”