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Treatment of hemicrania continua: case series and literature review
Lídia Maria Veras Rocha de Moura1, José Marcelo Ferreira Bezerra, Norma Regina Pereira Fleming
1Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, RJ, Brazil. jnrlidia@gmail.com
Insights
Hemicrania continua (HC) is a disabling headache. Alternative treatments like amitriptyline, gabapentin, and topiramate show promise when indomethacin is not suitable or causes side effects.
Area of Science:
- Neurology
- Headache Medicine
Background:
- Hemicrania continua (HC) is a primary, disabling headache.
- It presents with continuous unilateral pain and is often responsive to indomethacin.
- Symptoms can overlap with trigeminal-autonomic cephalalgias and migraine, complicating diagnosis.
Purpose of the Study:
- To describe Hemicrania Continua (HC) in a case series.
- To review evidence on alternative therapies for HC.
- To highlight diagnostic challenges and treatment options beyond indomethacin.
Main Methods:
- Systematic review of medical records and pain diaries.
- Analysis of 1,600 patients treated between 1992 and 2011.
- Selection of ten patients with possible HC diagnosis for detailed review.
Main Results:
- Seven out of ten selected patients were diagnosed with HC.
- Patients experienced an average diagnostic delay of 12 years.
- Prophylactic treatment showed efficacy: amitriptyline (66.6%), gabapentin (20%), topiramate (10%).
Conclusions:
- HC should be considered in continuous headache cases without neurological changes.
- Standard indomethacin treatment carries significant short- and long-term risks.
- Alternative therapies including gabapentin, topiramate, and amitriptyline show potential efficacy.
Background And Objectives:
Hemicrania Continua (HC) is a primary, disabling headache characterized by a continuous unilateral pain and responsive to indomethacin. There are symptoms common to the trigeminal-autonomic cephalalgias and migraine that complicate the diagnosis. This review aims to describe HC in a case series and review the best available evidence on alternative therapies.
Method:
A systematic review of medical records and diaries of pain of 1,600 patients treated between January 1992 and January 2011 in a headache outpatient clinic.
Results:
Ten patients with a possible diagnosis of hemicrania continua were selected; seven were diagnosed with HC according to the II International Classification of Headache Disorders. None of the patients had received the correct diagnosis before being treated at the outpatient clinic and the average time for treatment was 12 years. Prophylactic treatment was effective in 66.6% of cases with amitriptyline, 20% with gabapentin and 10% with topiramate.
Conclusions:
HC should be considered among the diagnostic hypotheses of patients with continuous headache, with no change in neurological examination and additional tests, regardless the age of onset. The standard treatment with indomethacin (100-150mg.day(-1)) has significant risks associated with both short and long term use and may not be a good choice for continuous use. Recent studies point out possible alternatives: gabapentin, topiramate, cyclooxygenase-2 inhibitors, piroxicam, beta-cyclodextrin, amitriptyline, melatonin. Other drugs were described in different reports as efficient, but most of them were considered inefficient in other HC cases.
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