Neuro Disorders: Hemicrania Continua

Introduction

Hemicrania Continua (HC) as the name implies is a continuous type of headache (HA) and involves characteristically only one side of the head (hemicrania).

It is considered to be a primary headache indicating there is no brain structural pathologies or any kind of pathologies out side the brain to explain the headache. Other examples for primary HA include migraine, tension, cluster types of HA.

Clinical Manifestations

It is an example for daily and continuous or almost continuous HA. For the definition purpose it should be present at least for 3 months on daily continuous fashion. The HA occurs on the same side without shifting the side. Severity and nature of HA varies.

Women are affected more than men. Adults are affected more than the extremes of age. This HA affects has no racial or ethnic predilection.

Autonomic disturbances like conjunctival injection, tearing, nasal secretions, drooping of eyelids, constriction of the pupil (miosis) etc are seen, not necessarily all these features in the same patient.

Diagnosis

The diagnosis is established based on characteristic clinical features as well as on the prompt response to indomethacin, a pain killer belonging to NSAID group.

A CT or MRI of head with & without contrast is necessary if the diagnosis is not established clinically. A spinal tap and/or certain blood tests are rarely necessary.

Treatment

Indomethacin is the drug of choice for both acute attacks and for the future prevention of attacks. Other NSAIDs (non steroidal anti inflammatory drugs) like celecoxib can be tried. NSAIDs especially indomethacin needs a gastric protector to be taken along with it like misoprostol, antacids, H2 blockers, PPI proton pump inhibitors etc. Topiramate is another option for long term treatment.

A neurologist is frequently involved in the care of patients with Hemicrania Continua.



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