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Primary continuous unilateral headaches: a nosologic model for hemicrania continua.
Juan A Pareja1, María-Luz Cuadrado, César Fernández-de-las-Peñas
1Fundación Alcorcón University Hospital, Alcorcón, Madrid, Spain. japareja@fhalcorcon.es
Cephalalgia : an International Journal of Headache
|March 13, 2012
Summary
Hemicrania continua, a continuous unilateral headache, is now recognized in forms that do not respond to indomethacin. This suggests a distinction between responsive hemicrania continua and non-responsive hemicrania incerta, aiding precise diagnosis.
Area of Science:
- Neurology
- Headache Medicine
Background:
- Hemicrania continua is defined as a continuous, strictly unilateral headache.
- A key diagnostic feature is its absolute response to indomethacin.
- Controversy exists regarding patients with similar symptoms but lacking indomethacin response.
Purpose of the Study:
- To address the controversy surrounding indomethacin-responsive and non-responsive phenotypes of continuous unilateral headaches.
- To propose a clearer diagnostic framework for primary continuous unilateral headaches.
Main Methods:
- Clinical feature analysis of patients with continuous unilateral headaches.
- Evaluation of treatment response, specifically to indomethacin.
Main Results:
- Identified two distinct categories within primary continuous unilateral headache.
- Hemicrania continua shows absolute response to indomethacin.
- A non-responsive phenotype, termed hemicrania incerta, is proposed.
Conclusions:
- The non-responsive phenotype (hemicrania incerta) should be differentiated from classic hemicrania continua.
- This differentiation improves diagnostic precision for controversial cases.
- Both entities may represent a spectrum within primary continuous unilateral headaches.
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