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Hemicrania continua
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Hemicrania continua
Hemicrania continua (HC) is a persistent unilateral headache that responds to indomethacin. It is usually unremitting, but rare cases of remission have been documented. Hemicrania continua is considered a primary headache disorder, meaning that another condition does not cause it.
In hemicrania continua, basal pain is a dull aching pressure similar to that of TTHs (Tension-Type Headaches) that occurs nearly always on the same side of the head and face. Pain ranges from mild to severe and is characterized by fluctuations that increase in intensity up to three to five times per 24-hour cycle. The range of duration of exacerbations has no boundaries and varies from a few seconds to up to two weeks. While attacks tend to be more frequent at night, no circadian periodicity such as in cluster headache can be observed.
The nature of pain changes during the exacerbation phase, becoming more piercing, throbbing, and intense, generally paired with other highly debilitating symptoms such as nausea, vomiting, dizziness, and sensitivity to light and sounds. During these exacerbation phases, hemicrania continua may mimic other primary and secondary headache disorders, with up to 70% of patients fulfilling the diagnostic criteria for migraine. Physical exertion, changes in sleep patterns, stress, or alcohol consumption can make the headache pain more severe in some patients.
In addition to the persistent daily headache of HC, which is usually mild to moderate (and frequently severe), HC can present other symptoms. These additional symptoms of HC can be divided into three main categories:
The cause of primary hemicrania continua is unknown. Although one case of familial hemicrania continua has been reported, no genetic susceptibility has been confirmed.
The following diagnostic criteria are given for hemicrania continua:
A variant on hemicrania continua has also been described, in which the attacks may shift sides, although meeting the above criteria in all other respects.
There is no definitive diagnostic test for hemicrania continua. Diagnostic tests such as imaging studies may be ordered to rule out other causes for the headache. When the symptoms of hemicrania continua are present, it's considered "diagnostic" if they respond completely to indomethacin. The efficacy of indomethacin may not be long term for all patients, as can eventually become ineffective.
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Hemicrania continua
Hemicrania continua (HC) is a persistent unilateral headache that responds to indomethacin. It is usually unremitting, but rare cases of remission have been documented. Hemicrania continua is considered a primary headache disorder, meaning that another condition does not cause it.
In hemicrania continua, basal pain is a dull aching pressure similar to that of TTHs (Tension-Type Headaches) that occurs nearly always on the same side of the head and face. Pain ranges from mild to severe and is characterized by fluctuations that increase in intensity up to three to five times per 24-hour cycle. The range of duration of exacerbations has no boundaries and varies from a few seconds to up to two weeks. While attacks tend to be more frequent at night, no circadian periodicity such as in cluster headache can be observed.
The nature of pain changes during the exacerbation phase, becoming more piercing, throbbing, and intense, generally paired with other highly debilitating symptoms such as nausea, vomiting, dizziness, and sensitivity to light and sounds. During these exacerbation phases, hemicrania continua may mimic other primary and secondary headache disorders, with up to 70% of patients fulfilling the diagnostic criteria for migraine. Physical exertion, changes in sleep patterns, stress, or alcohol consumption can make the headache pain more severe in some patients.
In addition to the persistent daily headache of HC, which is usually mild to moderate (and frequently severe), HC can present other symptoms. These additional symptoms of HC can be divided into three main categories:
The cause of primary hemicrania continua is unknown. Although one case of familial hemicrania continua has been reported, no genetic susceptibility has been confirmed.
The following diagnostic criteria are given for hemicrania continua:
A variant on hemicrania continua has also been described, in which the attacks may shift sides, although meeting the above criteria in all other respects.
There is no definitive diagnostic test for hemicrania continua. Diagnostic tests such as imaging studies may be ordered to rule out other causes for the headache. When the symptoms of hemicrania continua are present, it's considered "diagnostic" if they respond completely to indomethacin. The efficacy of indomethacin may not be long term for all patients, as can eventually become ineffective.