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2017 ; 10
(ä): 1493-1509
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Hemicrania continua: clinical review, diagnosis and management
#MMPMID28721092
Prakash S
; Patel P
J Pain Res
2017[]; 10
(ä): 1493-1509
PMID28721092
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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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