The factor that allows hemicrania continua and its exacerbations to be differentiated from migraine and cluster headache is that hemicrania continua is completely responsive to indomethacin. Triptans and other abortive medications do not affect hemicrania continua.
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Hemicrania continua (HC) is a persistent unilateral headache that responds to indomethacin. It is usually unremitting, but rare cases of remission have been documented.Mark Thompson, "Hemicrania Continua" Hemicrania continua is considered a primary headache disorder, meaning that it is not caused by another condition.
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"Chronic Paroxysmal Hemicrania And Hemicrania Continua Responding To Topiramate: Two Case Reports." Clinical Neurology & Neurosurgery 100.1 (2008): 88-91. Academic Search Complete. Web. 27 Feb. 2014.
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"Chronic Paroxysmal Hemicrania." Chronic Daily Headache for Clinicians. Hamilton, Ont.: BC Decker, 2005.
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Paroxysmal hemicrania is classified by the frequency and duration of attacks experienced by patients. Episodic paroxysmal hemicrania attacks occur at least twice a year and last anywhere from seven days to a year with pain free periods of a month or longer separating them. Chronic paroxysmal hemicrania attacks occur over the course of more than a year without remission or with remissions lasting less than a month. Goadsby, Peter J., Stephen D. Silberstein, and David Dodick.
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The International Headache Society's International Classification of Headache Disorders classifies hemicrania continua as a primary headache disorder.
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"Dose, Efficacy and Tolerability of Long-term Indomethacin Treatment of Chronic Paroxysmal Hemicrania and Hemicrania Continua." Cephalalgia 21.9 (2001): 906-10. Print. Almost all cases of CPH respond positively and effectively to indometacin, but as much as 25 percent of patients discontinued use of the drug due to adverse side effects, namely complications in the gastrointestinal tract. Camarda, Cecilia, Rosolino Camarda, and Roberto Monastero.
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Eadie, Mervyn J. "Chronic Paroxysmal Hemicrania." Headache: Through the Centuries. New York: Oxford UP, 2012. 222-24. Print. CPH has been included in the International Headache Society's classification system since 1988.
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CPH was discovered by Norwegians Ottar Sjaastad and Inge Dale in 1974. The term 'chronic paroxysmal hemicrania' was first used in 1976 by Sjaastad to describe a condition seen in two of their patients who were experiencing repeated solitary and limited daily headache attacks on only one side of the cranium. It is possible that chronic paroxysmal hemicrania was first described by Johann Oppermann in 1747 under the term "hemicranias horologica". Oppermann's report included a 35-year-old woman who had hemicranial pain that lasted for 15 minutes and recurred regularly every hour.
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Hemicrania was mentioned in 1881 in The Therapeutic Gazette Vol. 2, by G.S.Davis, and the incident has been cited in King's American Dispensatory (1898 and later editions) in the description of the strong analgesic Jamaican Dogwood, a relatively low dose of which reportedly produced convulsions and prolonged respiratory depression over six hours in an elderly woman with this condition. In newer times, Hemicrania continua was described in 1981; at that time around 130 cases were described in the literature. However, rising awareness of the condition has led to increasingly frequent diagnosis in headache clinics, and it seems that it is not as rare as these figures would imply.
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Milanlioglu, A., T. Tombul, and R. Sayin. "Chronic Paroxysmal Hemicrania Responsive to Lamotrigine." Pak J Med Sci 27.2 (2011): 456-57. Web. Use of topiramate has also been found to be an effective treatment for CPH, but cluster headache medications have been found to have little effect.
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Exact statistical data is not available due to common mis-diagnosis, and setting up diagnostic criteria is important. The International Headache Classification established by the International Headache Society criteria for diagnosing SUNCT for therapeutic purposes is: :(i) Type of attack – Attacks of unilateral orbital, supraorbital, or temporal areas from stabbing or pulsating pain accompanied by ipsilateral conjunctival injection and lacrimation :(ii) Number of attacks per day – 3 to 200 attacks per day :(iii) Attack load in minutes per day – 5–240 seconds Symptoms of SUNCT often lead to misdiagnosis as paroxysmal hemicrania, which is also categorized in the same group. Inefficiency of indomethacin usually indicates SUNCT over paroxysmal hemicrania. Misdiagnosis and indecisive diagnosis in the past has made it difficult to obtain accurate statistics about SUNCT.
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Chronic paroxysmal hemicrania (CPH) is a severe debilitating unilateral headache usually affecting the area around the eye. It normally consists of multiple severe, yet short, headache attacks affecting only one side of the cranium. It is more commonly diagnosed in women than in men, but, unlike a migraine, has no neurological symptoms associated with it. CPH headaches are treated through the use of non-steroidal anti-inflammatory drugs, with indomethacin found to be usually effective in eliminating symptoms.
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Migraine without aura also referred to as a common migraine, (previously known as hemicrania simplex) is a specific neurological disorder characterized by recurrent, throbbing headaches that often affect one side of the head (i.e., it is unilateral), are of at least moderate pain intensity, and may cause nausea, phonophobia or photophobia. One defining characteristic of the common migraine is a lack of the visual disturbances known as an aura. The exact International Classification of Headache Disorders diagnostic criteria appear to the right.
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For diagnosis of hypnic headache syndrome, headaches should occur at least 15 times per month for at least one month. Included in the differential diagnosis of a new onset nighttime headaches in the elderly is drug withdrawal, temporal arteritis, Sleep apnea, oxygen desaturation, Pheochromocytoma, intracranial causes, primary and secondary neoplasms, communicating hydrocephalus, subdural hematoma, vascular lesions, migraines, cluster headaches, chronic paroxysmal hemicrania, headaches due to bruxism, and hypnic headache. All other causes must be ruled out before the diagnosis of hypnic headache can be made.
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The Head Ache, George Cruikshank (1819) An early description consistent with migraine is contained in the Ebers papyrus, written around 1500 BCE in ancient Egypt. In 200 BCE, writings from the Hippocratic school of medicine described the visual aura that can precede the headache and a partial relief occurring through vomiting. A second-century description by Aretaeus of Cappadocia divided headaches into three types: cephalalgia, cephalea, and heterocrania. Galen of Pergamon used the term hemicrania (half-head), from which the word migraine was eventually derived.
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In an interview on CBS News Sunday Morning on April 1, 2012, Smith explained the album's title: "for those who are curious, you can find what Banga is if you read The Master and Margarita by Bulgakov." N.B. References are found from 3:42–5:27 in the embed video. In The Master and Margarita, Banga is Pontius Pilate's dog to whom Pilate could freely complain about the hemicrania that tortured him. Other songs on the album were also inspired by literature, particularly "April Fool," inspired by Nikolai Gogol.
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Hemicrania continua generally responds only to indomethacin 25–300 mg daily, which must be continued long term. Unfortunately, gastrointestinal side effects are a common problem with indomethacin, which may require additional acid-suppression therapy to control. In patients who are unable to tolerate indomethacin, the use of celecoxib 400–800 mg per day (Celebrex) and rofecoxib 50 mg per day (Vioxx - no longer available) have both been shown to be effective and are likely to be associated with fewer GI side effects. There have also been reports of two patients who were successfully managed with topiramate 100–200 mg per day (Topamax) although side effects with this treatment can also prove problematic.
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The adenoma may be the prime causative factor behind the headache or may serve to exacerbate a headache caused by other factors. Amongst the types of headaches experienced are both chronic and episodic migraine, and more uncommonly various unilateral headaches; primary stabbing headache, short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) \- another type of stabbing headache characterized by short stabs of pain -, cluster headache, and hemicrania continua (HS). Compressive symptoms of pituitary adenomas (visual field deficits, decreased visual acuity, headaches) are more commonly seen with macroadenomas (which are greater than 10 mm in diameter) than with microadenomas (which are less than 10 mm in diameter). Non-secreting adenomas can go undetected for an extended time because no obvious abnormalities are seen; the gradual reduction in normal activities due to decreased production of hormones is rather less evident.
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