Hemicrania Continua





Key words

autonomic trigeminal cephalgias, chronic paroxysma hemicranias, cluster headache, hemicrania continuas, horner’s syndrome, indomethacin, indomethacin responsive headaches, sjaastad syndrome, trigeminal autonomic cephalgias, unilateral headaches

 





ICD-10 CODE G44.51





Clinical Syndrome


Hemicrania continua is a primary headache disorder that is classified as a trigeminal autonomic cephalgia that shares characteristics of both cluster headache and migraine headache ( Table 4.1 ). Similar to cluster headache, hemicrania continua is a severe, unilateral headache with associated signs of autonomic dysfunction, including lacrimation, scleral injection, eyelid ptosis, and nasal stuffiness syndrome ( Fig. 4.1 ). In contrast to cluster headache, which occurs 10 times more commonly in men, hemicrania continua occurs more commonly in women, a characteristic it shares with migraine. Like migraine headache, hemicrania continua is associated with nausea and vomiting, as well as sonophobia and phonophobia. Unlike the pain of cluster and migraine headache, the pain of hemicrania continua is continuous with intermittent severe exacerbations of pain. This pain is unilateral and is side locked (i.e., it does not change sides like migraine headache occasionally does). Hemicrania continua is an indomethacin responsive headache, with complete resolution of headache and associated symptoms with therapeutic doses of indomethacin. The cause of hemicrania continua is unknown, but like other trigeminal autonomic cephalgias, functional magnetic resonance scanning and positron emission tomography reveal activation in the posterior hypothalamus during exacerbation of headaches.



TABLE 4.1

Comparison of Cluster Headache and Hemicrania Continua



























































Comparison Factors Cluster Headache Hemicrania Continua Migraine Headache
Gender predominance Male Female Female
Absolute response to indomethacin Negative Positive Negative
Chronobiological pattern Positive Negative Negative
Alcohol trigger Positive Negative Sometimes
Length of attacks Longer Continuous, with exacerbations Longer than cluster headache
Autonomic symptoms, lacrimation, scleral injection, eyelid ptosis, nasal stuffiness syndrome Present Present Negative
Photophobia Negative Positive Positive
Sonophobia Negative Positive Positive
Nausea and vomiting Negative Positive Positive
Continuous pain with exacerbations Negative Positive Negative



Fig. 4.1


Hemicrania continua is a unilateral side-locked headache with associated signs of autonomic dysfunction. In contrast to cluster headache, which occurs primarily in men, hemicrania continua occurs primarily in women.




Signs and Symptoms


During attacks of hemicrania continua, patients exhibit the following physical findings suggestive of Horner syndrome on the ipsilateral side of the pain:




  • Conjunctival and scleral injection



  • Lacrimation



  • Nasal congestion



  • Rhinorrhea



  • Ptosis of the eyelid



As in cluster headache, the patient may become agitated during attacks, rather than seeking dark and quiet as does the patient with migraine. In contrast to cluster headache, alcohol consumption does not seem to trigger attacks of hemicrania continua. Between attacks, the neurological examination of a patient with hemicrania continua should be normal.

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Feb 9, 2020 | Posted by in PAIN MEDICINE | Comments Off on Hemicrania Continua

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