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Rigorously defined hemicrania continua presenting bilaterally
Andrew M Southerland1, Ivan S Login
1University of Virginia Health System, Charlottesville, 22908, USA. as5ef@virginia.edu
Cephalalgia : an International Journal of Headache
|August 2, 2011
Summary
Hemicrania continua (HC), a continuous headache disorder, can present bilaterally. This case highlights that a bilateral headache with autonomic features may respond completely to indomethacin, suggesting it is a viable treatment option.
Area of Science:
- Neurology
- Headache Medicine
Background:
- Hemicrania continua (HC) is a primary headache disorder defined by continuous unilateral pain, autonomic symptoms, and indomethacin responsiveness.
- HC shares features with trigeminal autonomic cephalalgias and chronic daily headaches like chronic migraine.
- Diagnostic delays in HC occur due to low incidence and phenotypic variability.
Observation:
- A 62-year-old woman experienced 5 months of continuous bilateral headache with autonomic symptoms.
- Neurological exams and imaging were unremarkable.
- The patient failed multiple treatments before responding to indomethacin.
Findings:
- This case illustrates that hemicrania continua can manifest as a purely bilateral headache.
- The patient achieved complete pain resolution and remission with indomethacin treatment.
Implications:
- Bilateral headache presentations should be considered within the spectrum of hemicrania continua.
- A therapeutic trial of indomethacin is warranted for bilateral headaches with autonomic features meeting HC criteria.
- This case expands the understanding of HC's clinical presentation and diagnostic considerations.
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