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Hemicrania continua: recent treatment strategies and diagnostic evaluation
1Sao Paulo Headache Center, Rua. Maestro Cardim 887, Sao Paulo, 01323-001, Brazil. marioperes@yahoo.com
Insights
Hemicrania continua (HC) is a continuous, one-sided headache disorder. While once rare, it is now recognized as an underdiagnosed syndrome effectively treated with indomethacin.
Area of Science:
- Neurology
- Headache Medicine
Background:
- Hemicrania continua (HC) is a primary headache disorder.
- Characterized by continuous unilateral headache of moderate severity with pain exacerbations.
- Previously considered rare, HC is increasingly reported and recognized as an underdiagnosed syndrome.
Purpose of the Study:
- To provide an overview of Hemicrania continua.
- To discuss its diagnostic features and treatment options.
Main Methods:
- Literature review of Hemicrania continua cases and characteristics.
- Analysis of diagnostic criteria and therapeutic responses.
Main Results:
- HC presents as a continuous or remitting unilateral headache.
- Complete responsiveness to indomethacin is a hallmark feature.
- Variants like HC with aura exist, and secondary causes are possible.
Conclusions:
- Indomethacin remains the gold standard treatment for HC.
- Other NSAIDs, including COX-2 inhibitors, may also provide relief.
- Increased recognition and reporting are improving the diagnosis of this headache syndrome.
Abstract:
Hemicrania continua (HC) is a primary headache disorder that is characterized by a continuous unilateral headache of moderate severity, exacerbations of severe pain, and complete responsiveness to indomethacin. HC was once thought to be a rare headache disorder, but now many cases have been reported. It is an underecognized headache syndrome. HC can be of continuous or remitting form. Variants such as hemicrania continua with aura have been described, and secondary cases may occur. Indomethacin is the best treatment, although HC could respond to other nonsteroidal anti-inflammatory drugs, such as the selective cyclo-oxygenase-2 inhibitors.