Hemicrania Continua: a Clinical Perspective on Diagnosis and Management

Curr Neurol Neurosci Rep. 2018 Oct 17;18(12):95. doi: 10.1007/s11910-018-0899-2.

Abstract

Purpose of review: Hemicrania Continua (HC) is a daily and persistent form of headache that is characterized by side-locked pain which is continuous, varies in severity and can be associated with conjunctival injection, lacrimation, nasal congestion, rhinorrhea, eyelid edema, forehead or facial sweating and miosis and/or ptosis.

Recent findings: Functional imaging studies have shown activation of subcortical structures such as the posterior hypothalamus and dorsal rostral pons, which are known to disinhibit the trigeminal autonomic reflex, a reflex responsible for autonomic outflow through trigeminal efferents. A similar pathway activation is seen in other Trigeminal autonomic cephalalgias (TAC) which solidifies HC as a TAC. While we also discuss promising treatments in our review, more evidence is needed before making them a standard of therapy for HC. This article aims to review the recent research on the diagnosis and clinical management of this potentially underdiagnosed primary headache disorder.

Keywords: Headache; Hemicrania continua; Indomethacin; Trigeminal autonomic Cephalgia; Unilateral headache.

Publication types

  • Review

MeSH terms

  • Headache / diagnosis*
  • Headache / diagnostic imaging
  • Headache / drug therapy*
  • Humans
  • Pons / diagnostic imaging
  • Trigeminal Autonomic Cephalalgias / diagnosis
  • Trigeminal Autonomic Cephalalgias / diagnostic imaging
  • Trigeminal Autonomic Cephalalgias / drug therapy