- 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
- Professor 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 .
- Matharu MS, Cohen AS, McGonigle DJ, et al. Posterior hypothalamic and brainstem activation in hemicrania continua. Headache 2004; 44:747.
- Goadsby PJ, Matharu MS, Boes CJ. SUNCT syndrome or trigeminal neuralgia with lacrimation. Cephalalgia 2001; 21:82.
- Sjaastad O, Spierings EL. "Hemicrania continua": another headache absolutely responsive to indomethacin. Cephalalgia 1984; 4:65.
- Peres MF, Silberstein SD, Nahmias S, et al. Hemicrania continua is not that rare. Neurology 2001; 57:948.
- Dodick D. Hemicrania continua: diagnostic criteria and nosologic status. Cephalalgia 2001; 21:869.
- Cittadini E, Goadsby PJ. Hemicrania continua: a clinical study of 39 patients with diagnostic implications. Brain 2010; 133:1973.
- Bordini C, Antonaci F, Stovner LJ, et al. "Hemicrania continua": a clinical review. Headache 1991; 31:20.
- Matharu MS, Boes CJ, Goadsby PJ. Management of trigeminal autonomic cephalgias and hemicrania continua. Drugs 2003; 63:1637.
- Prakash S, Golwala P. A proposal for revision of hemicrania continua diagnostic criteria based on critical analysis of 62 patients. Cephalalgia 2012; 32:860.
- Newman LC, Lipton RB, Solomon S. Hemicrania continua: ten new cases and a review of the literature. Neurology 1994; 44:2111.
- Bigal ME, Tepper SJ, Rapoport AM, Sheftell FD. Hemicrania continua: comparison between two different classification systems. Cephalalgia 2002; 22:242.
- Peres MF, Siow HC, Rozen TD. Hemicrania continua with aura. Cephalalgia 2002; 22:246.
- Matharu MS, Bradbury P, Swash M. Hemicrania continua: side alternation and response to topiramate. Cephalalgia 2006; 26:341.
- Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 2013; 33:629.
- Marmura MJ, Silberstein SD, Gupta M. Hemicrania continua: who responds to indomethacin? Cephalalgia 2009; 29:300.
- Antonaci F, Pareja JA, Caminero AB, Sjaastad O. Chronic paroxysmal hemicrania and hemicrania continua. Parenteral indomethacin: the 'indotest'. Headache 1998; 38:122.
- Eross EJ, Swanson JW, Dodick DW. Hemicrania continua: an indomethacin-responsive case with an underlying malignant etiology. Headache 2002; 42:527.
- Antonaci F, Sjaastad O. Hemicrania continua: a possible symptomatic case, due to mesenchymal tumor. Funct Neurol 1992; 7:471.
- Valença MM, Andrade-Valença LP, da Silva WF, Dodick DW. Hemicrania continua secondary to an ipsilateral brainstem lesion. Headache 2007; 47:438.
- Rogalewski A, Evers S. Symptomatic hemicrania continua after internal carotid artery dissection. Headache 2005; 45:167.
- Peres MF, Zukerman E, Porto PP, Brandt RA. Headaches and pineal cyst: a (more than) coincidental relationship? Headache 2004; 44:929.
- Levy MJ, Matharu MS, Meeran K, et al. The clinical characteristics of headache in patients with pituitary tumours. Brain 2005; 128:1921.
- DeLange JM, Robertson CE, Krecke KN, Garza I. A case report of hemicrania continua-like headache due to ipsilateral inflammatory orbital pseudotumor. Headache 2014; 54:1541.
- Peres MF, Silberstein SD. Hemicrania continua responds to cyclooxygenase-2 inhibitors. Headache 2002; 42:530.
- Rozen TD. Verapamil-responsive hemicrania continua in a patient with episodic cluster headache. Cephalalgia 2006; 26:351.
- Spears RC. Hemicrania continua: a case in which a patient experienced complete relief on melatonin. Headache 2006; 46:524.
- Rozen TD. Melatonin responsive hemicrania continua. Headache 2006; 46:1203.
- Schwedt TJ, Dodick DW, Hentz J, et al. Occipital nerve stimulation for chronic headache--long-term safety and efficacy. Cephalalgia 2007; 27:153.
- Miller S, Correia F, Lagrata S, Matharu MS. OnabotulinumtoxinA for hemicrania continua: open label experience in 9 patients. J Headache Pain 2015; 16:19.
- Garza I, Cutrer FM. Pain relief and persistence of dysautonomic features in a patient with hemicrania continua responsive to botulinum toxin type A. Cephalalgia 2010; 30:500.
- Pareja J, Sjaastad O. Chronic paroxysmal hemicrania and hemicrania continua. Interval between indomethacin administration and response. Headache 1996; 36:20.
- Pareja JA, Caminero AB, Franco E, et al. Dose, efficacy and tolerability of long-term indomethacin treatment of chronic paroxysmal hemicrania and hemicrania continua. Cephalalgia 2001; 21:906.
- CLINICAL FEATURES
- Diagnostic indomethacin trial
- DIFFERENTIAL DIAGNOSIS
- Secondary hemicrania continua
- Chronic migraine
- Other trigeminal autonomic cephalalgias
- Indomethacin dose
- Indomethacin side effects
- SUMMARY AND RECOMMENDATIONS