Hemicrania continua. Unquestionably a trigeminal autonomic cephalalgia

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Maurice B Vincent1

  • 1Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.

Headache
|April 12, 2013
PubMed

Insights

Hemicrania continua (HC) is reclassified as a trigeminal autonomic cephalalgia, not a miscellaneous headache. Evidence shows shared clinical features, indomethacin response, and hypothalamic activation with other TACs.

Area of Science:

  • Neurology
  • Headache Medicine

Background:

  • Hemicrania continua (HC) is currently classified under 'other primary headaches' in the International Classification of Headache Disorders.
  • Emerging evidence suggests HC shares characteristics with trigeminal autonomic cephalalgias (TACs).

Purpose of the Study:

  • To evaluate the evidence supporting the reclassification of Hemicrania continua (HC) as a trigeminal autonomic cephalalgia (TAC).
  • To consolidate clinical, therapeutic, and neuroimaging data to support HC's placement within the TAC spectrum.

Main Methods:

  • Review of clinical presentations of HC and other TACs (cluster headache, paroxysmal hemicrania, SUNHA).
  • Analysis of treatment responses, particularly to indomethacin.
  • Examination of neuroimaging findings, focusing on hypothalamic activation patterns.

Main Results:

  • HC exhibits a shared clinical profile with TACs: paroxysmal, unilateral, side-locked headaches with ipsilateral autonomic symptoms.
  • Indomethacin demonstrates a unique and potent efficacy in HC, mirroring its effect in paroxysmal hemicrania.
  • Neuroimaging reveals posterior hypothalamic activation in HC, consistent with other TACs.

Conclusions:

  • Hemicrania continua (HC) demonstrates sufficient shared features with cluster headache, paroxysmal hemicrania, and SUNHA to be classified as a trigeminal autonomic cephalalgia.
  • The current classification of HC as a miscellaneous primary headache is outdated and does not reflect its underlying pathophysiology.
  • HC should be integrated into the spectrum of trigeminal autonomic cephalalgias based on clinical, therapeutic, and neuroimaging evidence.

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