Friday, 29 November 2013

Hemicrania continua (HC) - Symptoms, Causes and Risk factors

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.

I. Symptoms
In the report of two patients with side-shifting HC with aura, showed that these patients' symptoms are [1]unilateral headaches, [2]visual aura, [3]autonomic features, [4]throbbing pain, [5]nausea and [6]photo/phonophobia(2), runny nose[7], tearing and redness of the eyes[8], sweating[9], drooping eyelids[10] nausea, vomiting[11] and sensitivity to light[12](3). Other symptoms include trigeminal-autonomic cephalalgias[13] and migraine[14] (4)

II. Causes and Risk factors
Some researchers suggested that that secondary or symptomatic HC is associated with another neurological or non-neurological disease. In the a report of three patients with secondary HC and the also review the literature to identify the clinical predictors of an underlying disease entity. Intracranial structural lesion, head and neck vessel pathology, and carcinoma lung should be suspected in every patient. The factors that may suggest a secondary pathology are: elderly age, male sex, smoking habit, constitutional symptoms, symptoms related to respiratory system, frequent and short-lived exacerbation, nocturnal exacerbation, HC evolving from remitting form, recent neck and/or head trauma, miosis, elevated ESR, and fading effect of indomethacin. We recommend MRI brain in all the patients presenting with HC or HC like headache. Angiography and CT chest are two other investigations that may be supplemented in patients with high risk for head/neck vessel pathology and carcinoma lung.(5).
Other researchers suggested that patient who suffered from cluster headache may evolving into ipsilateral HC, as they do not tolerate a long-term indomethacin therapy(6). Other found that HC is a life long condition, and skipping of a single dose of indomethacin usually leads to reappearance of headache(7)
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