Hemicrania continua: a possible symptomatic case, due to mesenchymal tumor

The case of a 28-year old woman with headache resembling hemicrania continua (HC) is described. Since her childhood she had a history of right-sided, side-locked, painful headache attacks, with increasing attack frequency during the last two years, each attack lasting around 24 hours. There were only a few "migrainous" symptoms and signs, thus no photo- and phono-phobia and no vomiting. Only occasionally did she have slight nausea. The clinical picture as well as the complete indomethacin effect suggested a case of HC. However, the indomethacin effect faded away after > 2 months. At that time, a CT scan revealed a tumor in the right sphenoidal bone involving the clinoid process and the base of the skull. A biopsy of the tumor during craniectomy showed a mesenchymal tumor, and the patient was considered inoperable (April, 1989). After cytostatic treatment, she is back in full time work; the headache disappeared and it still has not recurred after approximately 2 years of observation. Neuroradiological investigation should, therefore, be included in the work-up of patients with HC. At the present stage of knowledge, neuroradiological investigations should probably also be included when faced with a typical clinical picture.