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2018 ; 21
(Suppl 1
): S23-S30
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Hemicrania Continua
#MMPMID29720815
Prakash S
; Adroja B
Ann Indian Acad Neurol
2018[Apr]; 21
(Suppl 1
): S23-S30
PMID29720815
show ga
Hemicrania continua (HC) is an indomethacin responsive primary chronic headache
disorder which is currently classified as a subtype of trigeminal autonomic
cephalalgias (TACs). It is not very uncommon. There are >1000 cases of HC in the
literature, and it constitutes 1.7% of total headache in the clinic settings.
Misdiagnosis for HC is very common at all clinical settings. A diagnosis of HC is
missed even by neurologists and headache specialists. It is characterized by a
continuous strictly unilateral headache with superimposed exacerbations. Just
like other TACs, exacerbations are associated with cranial autonomic symptoms and
restlessness. A large number of patients may have migrainous features (nausea,
vomiting, photophobia, and phonophobia) during exacerbations phase. The "key"
feature of HC is persistent featureless background headaches. However, patients
and physicians may focus only on the exacerbation part. As durations, frequency
and associated symptoms of exacerbations are highly variables; it may mimic a
large number of primary and secondary headache disorders. Migraine and cluster
headache are two most common misdiagnosed conditions. Another specific feature of
HC is remarkable repose to indomethacin. A "complete" response to indomethacin is
as "sine qua non" for HC. However, a few other medications may also be effective
in a subset of HC patients. Various surgical procedures have been tried with
mixed results in patients who were intolerant to indomethacin or other drugs.