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"Hemicrania continua": a clinical review
C Bordini1, F Antonaci, L J Stovner
1Department of Neurology, Trondheim University Hospital, Norway.
Insights
Hemicrania continua (HC) is a rare headache disorder primarily affecting women and characterized by continuous, one-sided pain. This condition shows a significant female predominance and responds well to indomethacin treatment.
Area of Science:
- Neurology
- Headache Medicine
Background:
- Hemicrania continua (HC) is a distinct headache disorder.
- It is characterized by continuous, unilateral pain.
- HC is known for its complete responsiveness to indomethacin.
Purpose of the Study:
- To review and summarize the characteristics of previously described cases of Hemicrania continua.
- To analyze demographic data, pain patterns, and associated symptoms.
- To highlight novel observations regarding HC, such as female preponderance.
Main Methods:
- Literature review of 18 reported cases of Hemicrania continua since 1984.
- Analysis of patient demographics (gender ratio).
- Evaluation of headache characteristics including laterality, continuity, and intensity.
Main Results:
- A significant female preponderance was observed (15 females: 3 males, F:M ratio of 5.0).
- The headache is typically unilateral, remaining on one side, though bilateral involvement occurred in some severe cases.
- While initially continuous in 8 cases, 16 of 18 cases developed continuous pain over time. Pain intensity was generally moderate, with less pronounced autonomic features compared to other unilateral headaches.
Conclusions:
- Hemicrania continua exhibits a notable female predominance, a characteristic shared with chronic paroxysmal hemicrania.
- The headache typically evolves to a continuous pattern and is generally of moderate intensity.
- Autonomic symptoms are less severe in HC than in conditions like cluster headache or chronic paroxysmal hemicrania.
Abstract:
Hemicrania continua (HC) is a headache entity completely responsive to indomethacin. Since 1984, 18 cases have been described, 15 females and 3 males, i.e. a F:M ratio of 5.0. The finding of a female preponderance, like that in chronic paroxysmal hemicrania, is a new observation. HC is, in general, a unilateral headache in the sense that it sets in on one side and subsequently sticks to this side. In two cases, both sides might possibly be involved, when the pain was at its maximum. In another (somewhat dubious) case the headache was bilateral. The pain was continuous from the beginning in 8 of 18 cases (early stage ratio continuous: non-continuous = 0.8). Over time, the headache developed a continuous character in 16 of the 18 cases, producing a "continuous: non-continuous ratio" of 8:1. The intensity of pain generally was moderate and was not reported as excruciatingly severe by any patient. The autonomic involvement from a clinical point of view, was clearly less pronounced than that of other unilateral headaches, such as cluster headache and chronic paroxysmal hemicrania.