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Hemicrania continua: a case responsive to piroxicam-beta-cyclodextrin
M Trucco1, F Antonaci, G Sandrini
1Department of Neurology, Ospedali Riuniti di Pietra e Finale Ligure, Italy.
Headache
|January 1, 1992
Summary
A woman with chronic unilateral headaches found relief with indomethacin, a nonsteroidal anti-inflammatory drug. When gastric issues arose, piroxicam-beta-cyclodextrin provided complete symptom resolution and good tolerability.
Area of Science:
- Neurology
- Pain Medicine
Background:
- Hemicrania continua is a rare primary headache disorder characterized by continuous, unilateral pain with superimposed exacerbations.
- It is often associated with ipsilateral autonomic features and typically responds absolutely to indomethacin.
Observation:
- A 53-year-old woman presented with a 15-year history of unilateral headache, initially episodic but evolving into a continuous, burning pain in the left forehead and face.
- Mild ipsilateral autonomic symptoms were present.
- The patient experienced significant relief with indomethacin, supporting the diagnosis of hemicrania continua.
Findings:
- Continuous indomethacin treatment led to mild gastric discomfort.
- Switching to piroxicam-beta-cyclodextrin resulted in complete headache relief and excellent tolerability.
- This highlights an alternative therapeutic option for hemicrania continua when indomethacin is not well-tolerated.
Implications:
- Piroxicam-beta-cyclodextrin may be a viable and well-tolerated alternative NSAID for managing hemicrania continua.
- This case expands treatment options for patients suffering from this debilitating headache disorder.
- Further research into alternative NSAIDs for hemicrania continua is warranted.