Hemicrania continua (HC) is a chronic and persistent unilateral headache and considered as one of primary
headache disorders, according to International Headache Society's
International Classification(1), affecting 4 to 5% of the general
population.
Misdiagnosis
Diagnosis is difficult, in a report of a woman in her fifties, with a long history of side-locked unilateral headache, was hospitalized for left-sided side-locked paroxysmal headache
(attacks with 10-20 min duration), indicated that a retrospective
review of her medical history showed 15 years of unsuccessfully treated
unilateral headache, until she responded completely to rofecoxib. Ipsilateral cranial autonomic symptoms also supported the diagnosis of hemicrania continua, although these symptoms
presented before indomethacin was tried. Diagnostic delay and
misdiagnoses of unilateral headaches, as illustrated by this case, shows
the clinical controversies and difficulties in diagnosing and treating
this condition.(8).
Others suggested that Misdiagnosis of HC
is probably common in general neurology settings and other clinical
specialties. Dr. Peres MF and the team at the UNIFESP (Universidade
Federal de São Paulo), São Paulo, said "the gap between the
correct and misdiagnosis of this disorder. HC was once thought to be a rare headache disorder, but is, in fact, an under-recognized headache syndrome. HC can be of continuous or remitting form. Variants such as HC with aura have been described and secondary cases may occur"(9)
Diagnosis
many researchers believe the diagnosis of Hemicrania continua (HC) consists
of the symptoms and signs of [1]unilaterality without side shift; [2]absolute indomethacin effect; [3] and
long-lasting repetitive attacks of varying duration[4], eventually with a
chronic pattern, the pain being mild to severe[5](10).Other suggested clinically, HC is considered a syndrome with two pivotal
characteristics: (i) strictly unilateral (moderate, fluctuating,
relatively long-lasting) headache; and (ii) absolute response to
indomethacin. HC is further characterized by some ancillary, but mostly
"negative", features such as: (iii) relative paucity of accompaniments;
and (iv) lack of precipitating factors.(11)
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Sources
(8) http://www.ncbi.nlm.nih.gov/pubmed/21494306
(9) http://www.ncbi.nlm.nih.gov/pubmed/19769451
(10) http://www.ncbi.nlm.nih.gov/pubmed/11903280
(11) http://www.ncbi.nlm.nih.gov/pubmed/11843864
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