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Chronic paroxysmal hemicrania and hemicrania continua. Interval between indomethacin administration and response
1Department of Neurology, Trondheim (Norway) University Hospitals.
Insights
The time for indomethacin to relieve pain in hemicrania continua and chronic paroxysmal hemicrania varies significantly, often within 24 hours. Individual patient factors likely influence this response time for headache relief.
Area of Science:
- Neurology
- Pharmacology
Background:
- Indomethacin is a common treatment for certain headache disorders.
- Understanding the onset of clinical response is crucial for optimizing treatment protocols.
Purpose of the Study:
- To determine the interval between indomethacin dosage and clinical response in patients with hemicrania continua and chronic paroxysmal hemicrania.
- To identify factors influencing the timing of pain relief.
Main Methods:
- Assessed the time to pain relief after indomethacin administration in 12 hemicrania continua and 11 chronic paroxysmal hemicrania patients.
- Patients experienced significant pain prior to testing, and usual dosages were administered.
- Response intervals were recorded over multiple trials per patient.
Main Results:
- The average interval between indomethacin intake and pain relief ranged from 30 minutes to 48 hours in both headache types.
- Complete pain relief was achieved within 24 hours for most patients, often within 8 hours.
- Significant interindividual variability in response timing was observed.
Conclusions:
- The onset of indomethacin's analgesic effect in these headache disorders shows considerable variability.
- Differences in bioavailability or individual sensitivity may explain the varying response times.
- Guidelines for indomethacin testing in unilateral headaches are proposed based on these findings.
Abstract:
The interval between indomethacin dosage and clinical response was assessed in hemicrania continua (n = 12) and chronic paroxysmal hemicrania (n = 11) sufferers. The number of trials per patient ranged from 1 to 30. At the time of testing, the patients had "considerable" pain after discontinuation of the drug. The dosage used was the usual one for that patient at the given pain level; ie, 25 or 50 mg tid. All the patients had a complete, long-term response to treatment. Nevertheless, the average interval between drug intake and pain relief during the present study ranged between 30 minutes and 48 hours in both disorders. In most patients (10 in both groups), the indomethacin effect was complete within 24 hours, and frequently within 8 hours. It is suggested that interindividual differences in dosage and timing to abolish the headaches may be due to different bioavailability or individual sensitivity. Recommendations on indomethacin testing in unilateral headaches are given.