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Hemicrania continua and paroxysmal hemicrania: clinical and therapeutic characteristics in a series of 23 patients

S. Benítez-Rivero, C. González-Oria, T. Gómez-Caravaca, M. Bernal-Sánchez Arjona, M.D. Jiménez-Hernández [REV NEUROL 2014;59:337-344] PMID: 25297475 DOI: https://doi.org/10.33588/rn.5908.2014199

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Volumen 59 | Number 08 | Nº of views of the article 48.338 | Nº of PDF downloads 990 | Article publication date 16/10/2014

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ABSTRACT

INTRODUCTION Hemicranias are an uncommon type of headache characterised by strictly unilateral pain, either as a continuous, although fluctuating, headache in hemicrania continua (HC) or in the form of recurring attacks in paroxysmal hemicrania (PH). In both types of headache, an absolute response to indomethacin is reported. AIMS. To analyse the fulfilment of current diagnostic criteria for HC and PH and the recent introduction of HC within the group of trigeminal-autonomic cephalgias.

PATIENTS AND METHODS The clinical and therapeutic characteristics of patients diagnosed with HC or PH were evaluated retrospectively. Demographic and symptomatological information as well as data regarding the analogical pain scale and response to indomethacin were included.

RESULTS A sample of 12 HC (four males and eight females) was evaluated from a total of 520 cases (2.3%). Mean age at onset: 47.1 ± 16.4 years. Baseline pain intensity: 3.3 ± 1,9. Exacerbations: 9.2 ± 1.1. Eight cases (66.7%) presented autonomic symptoms, four (33.3%) followed a time pattern, and two (16.7%) did not respond to indomethacin. We evaluated a sample of 11 PH (100% females) from 520 cases (2.1%). Mean age at onset: 37.0 ± 13.9 years. Pain intensity: 8.7 ± 2.7. Nine cases (81.8%) presented autonomic symptoms, three (27.3%) followed a time pattern and one (9.1%) did not respond to indomethacin.

CONCLUSIONS Hemicranias are not frequently diagnosed in day-to-day clinical practice. Their diagnosis requires the fulfilment of certain criteria that are sometimes not fully satisfied. We believe that the criteria need revising and we also support the recent inclusion of HC within the group of trigeminal-autonomic cephalgias. KeywordsAutonomic symptoms Hemicrania continua Indomethacin Paroxysmal hemicrania Trigeminal-autonomic cephalgias Unilateral headache CategoriesCefalea y Migraña Dolor

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Hemicrania continua and paroxysmal hemicrania: clinical and therapeutic characteristics in a series of 23 patients

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