- Ivan Garza, MD
Ivan Garza, MD
- Assistant Professor of Neurology
- Mayo Clinic College of Medicine
- Todd J Schwedt, MD, MSCI
Todd J Schwedt, MD, MSCI
- Associate Professor
- Department of Neurology
- Mayo Clinic
Chronic daily headache is a descriptive term that encompasses several different specific headache diagnoses characterized by frequent headaches. Chronic daily headache types with individual headaches of long duration (ie, four hours or more) include chronic migraine, chronic tension-type headache, medication overuse headache, hemicrania continua, and new daily persistent headache.
This topic will discuss hemicrania continua, a unilateral headache that is continuous in nature. Other types of chronic daily headache are reviewed elsewhere. (See "Overview of chronic daily headache".)
The posterior hypothalamus and dorsal rostral pons play a role in the physiology of HC. A controlled positron emission tomography (PET) study of seven patients with HC showed significant activation of the contralateral posterior hypothalamus and ipsilateral rostral pons during baseline pain . This activation was blocked by administration of intramuscular indomethacin.
It is hypothesized that the presence of autonomic nervous system symptoms in HC is due, at least in part, to hypothalamic activation with secondary disinhibition of the trigeminal-autonomic reflex . A similar mechanism may be implicated in cluster headache and the SUNCT and SUNA headache syndromes. The exact role of the dorsal rostral pons in HC is unclear, but this region is also activated in migraine, and may play a role in the inhibition of nociceptive traffic along the trigeminovascular system.
The term "hemicrania continua" was coined in 1984 when the first cases were described . The true frequency of hemicrania continua (HC) in the general population is unknown, and only a few hundred cases have been published in the literature. However, one headache center identified 34 new cases of HC in three years, suggesting the disorder is more common than previously considered .
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- CLINICAL FEATURES
- Diagnostic indomethacin trial
- DIFFERENTIAL DIAGNOSIS
- Secondary hemicrania continua
- Chronic migraine
- Other trigeminal autonomic cephalalgias
- Indomethacin dose
- Indomethacin side effects
- SUMMARY AND RECOMMENDATIONS