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Headache Disorders
Published in Sahar Swidan, Matthew Bennett, Advanced Therapeutics in Pain Medicine, 2020
Chronic paroxysmal hemicrania is a rare syndrome marked by headaches of short duration, a high frequency of attacks, and associated autonomic symptoms. CPH pain location is normally orbital, temporal, and above or behind the ear and is one-sided. The pain is severe in intensity. Normal headache duration is between 2 and 30 minutes and frequency is greater than five attacks per day. Unlike cluster headache, there is no predilection for nocturnal attacks, although attacks can certainly awaken a patient from sleep. Associated symptoms are marked by autonomic phenomena. CPH attacks can sometimes be triggered by rotating the neck or flexing the head to the side of the headaches, or by applying external pressure to the transverse processes of C4–C5 or the C2 nerve root on the symptomatic side. This syndrome used to be termed female cluster headache but it is not cluster headache based on the frequency and duration of attacks, and a misdiagnosis can lead to continued disability as indomethacin is not suggested for CH but is for CPH. Hemicrania Continua
Chronic Headache Pain
Published in Andrea Kohn Maikovich-Fong, Handbook of Psychosocial Interventions for Chronic Pain, 2019
RuthAnn R. Lester, Eleanor S. Brammer, Allison Gray
Hemicrania continua is a chronic headache characterized by persistent, unilateral head pain that varies in severity and that is associated with at least one additional troublesome autonomic symptom (eye redness and/or tearing, nasal congestion and/or runny nose, ptosis, and miosis) (Pina-Garza, 2013). Hemicrania continua headaches generally are of moderate intensity with occasional short bursts of piercing head pain and persist for more than three months without shifting sides and/or without periods of pain freedom.
Tension-Type Headache
Published in Gary W. Jay, Clinician’s Guide to Chronic Headache and Facial Pain, 2016
Hemicrania continua is a continuous headache that waxes and wanes and involves both autonomic and migrainous symptoms. Patients suffer with nausea, vomiting, photophobia, phonophobia, as well as rhinorrhea, tearing, conjunctival injection, eye discomfort, sweating, and swollen/ drooping eyelids. Unlike the bilateral nature of CTTH, hemicrania continua is strictly unilateral (51-53). There may also be superimposed stabbing pain with hemicrania continua. In addition, hemicrania continua is almost always responsive to indomethacin (54).
Tolerability of pharmacological agents in the treatment of headache following brain injury: a scoping review
Published in Brain Injury, 2023
Heather M. MacKenzie, Michael Robinson, Amanda McIntyre
Two case reports (level 5 evidence) and one case series (level 4 evidence) (13,15,16) (n = 6) described the use of indomethacin for PTH. One case report (16) focused on an individual with chronic paroxysmal hemicrania, whereas the other two articles (13,15) involved individuals with hemicrania continua. The treatment dose of indomethacin ranged from 100 mg to 300 mg daily. Five out of six of the subjects experienced gastrointestinal upset/nausea as a side effect of indomethacin, including one individual who developed colitis; two of these individuals discontinued indomethacin due to this side effect. Of these five subjects, three required the addition of another pharmacological agent to counteract the gastrointestinal upset, specifically a proton pump inhibitor, misoprostol or famotidine. Of note, the sixth subject, who did not specifically report any gastrointestinal symptoms, was simultaneously prescribed misoprostol, which counteracts gastrointestinal inflammation. The subjects (n = 4) described by Lay et al. (13) reported that their headaches were “significantly better” or “significantly lessened” with indomethacin treatment. Evans et al. (15) described a reduction in headache frequency from daily to every other day; of note, this individual was concurrently treated with amitriptyline 25 mg at bedtime, but no tolerability information was provided for this medication. The subject in the article by Jacob et al. (16) reported a complete resolution of his headaches.
Therapeutic strategies that act on the peripheral nervous system in primary headache disorders
Published in Expert Review of Neurotherapeutics, 2019
János Tajti, Délia Szok, Aliz Nyári, László Vécsei
The TACs share the clinical features of unilateral headache and cranial autonomic features, which are ipsilateral to the headache [5]. Short-lasting unilateral neuralgiform headache attacks (SUNHA) are moderate or severe in intensity, strictly unilateral, lasting seconds to minutes, occurring at least once a day and usually associated with prominent lacrimation and redness of the ipsilateral eye [5]. Its two subtypes are short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA), both of them can be episodic or chronic [5]. These are rare disorders, the prevalence of SUNCT is 6.6/100.000 persons and SUNA five times less frequent [143]. Hemicrania continua (HC), either remitting or unremitting subtypes, is a persistent, strictly unilateral pain, associated with ipsilateral autonomic features and/or with restlessness or agitation. HC responds exclusively to indomethacin [5,144].
Neuromodulation for the treatment of primary headache syndromes
Published in Expert Review of Neurotherapeutics, 2019
Tso et al. [13]. explored the potential efficacy of nVNS in indomethacin-sensitive trigeminoautonomic cephalalgias (TAC), namely chronic paroxysmal hemicrania and hemicrania continua. All observed patients were responsive to indomethacin but either had to reduce or even discontinue the treatment due to adverse effects so that in this study in some patients nVNS was used as a monotherapy, in some as an add-on therapy to indomethacin used at the maximum tolerated dose. Of the nine patients with hemicrania continua and the six patients with chronic hemicrania continua had a significant improvement of their condition while only four patients (two with hemicrania continua and two with chronic paroxysmal hemicrania) had no response to nVNS [13]. Sham-controlled studies are clearly needed to confirm these findings.