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Hemicrania Continua: a Clinical Perspective on Diagnosis and Management

  • Headache (R B Halker Singh, Section Editor)
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Abstract

Purpose of Review

Hemicrania Continua (HC) is a daily and persistent form of headache that is characterized by side-locked pain which is continuous, varies in severity and can be associated with conjunctival injection, lacrimation, nasal congestion, rhinorrhea, eyelid edema, forehead or facial sweating and miosis and/or ptosis.

Recent Findings

Functional imaging studies have shown activation of subcortical structures such as the posterior hypothalamus and dorsal rostral pons, which are known to disinhibit the trigeminal autonomic reflex, a reflex responsible for autonomic outflow through trigeminal efferents. A similar pathway activation is seen in other Trigeminal autonomic cephalalgias (TAC) which solidifies HC as a TAC. While we also discuss promising treatments in our review, more evidence is needed before making them a standard of therapy for HC.

Summary

This article aims to review the recent research on the diagnosis and clinical management of this potentially underdiagnosed primary headache disorder.

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. Department of Neurology, Yale School of Medicine, New Haven, CT, USA

    Amit Mehta, Priyanka Chilakamarri, Adeel Zubair & Deena E. Kuruvilla

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  1. Amit Mehta
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  2. Priyanka Chilakamarri
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Correspondence to Amit Mehta.

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Conflict of Interest

Amit Mehta, Priyanka Chilakamarri, Adeel Zubair and Deena E. Kuruvilla each declare no potential conflicts of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Headache

Clinical Scenario

50-year-old male with a past medical history of depression presents with a right sided headache that has been persistent for 4 months. He reports a baseline pain level of 3/10 with episodic exacerbations rated a 9/10. During an exacerbation, he also experiences right eye tearing, right conjunctival injection and rhinorrhea. A therapeutic dose of indomethacin was given which completely resolved the patient’s symptoms.

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Mehta, A., Chilakamarri, P., Zubair, A. et al. Hemicrania Continua: a Clinical Perspective on Diagnosis and Management. Curr Neurol Neurosci Rep 18, 95 (2018). https://doi.org/10.1007/s11910-018-0899-2

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