Side-shifting hemicrania continua with aura (migraine with aura with autonomic symptoms responsive to indomethacin?).
Atypical features of hemicrania continua (HC), including both visual aura and side shifting, have been reported previously. However, auras and variable unilaterality have never been reported together in HC. We report two patients with side-shifting HC with aura. These patients' symptoms are unilateral headaches, visual aura, autonomic features, throbbing pain, nausea and photo/phonophobia. One could speculate that the unilaterality and/or the autonomic symptom modules are indomethacin responsive. The patients can also be classified as chronic migraine with aura, with autonomic symptoms, responsive to indomethacin. Neither migraine subtype nor side-shifting HC with aura is included in the current International Headache Society (IHS) classification, so these patients are not classifiable. Side-shifting HC with aura implies the need to revisit the traditional IHS categorization of headaches into unique diagnostic groups. The modular headache theory may be a tool for the understanding of these rare and complex cases.
Peres
M F P
MF
Instituto Israelita de Ensino e Pesquisa Albert Einstein, São Paulo, Brazil. marioperes@yahoo.com
Masruha
M R
MR
Young
W B
WB
D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001342:Autonomic Nervous System Diseases / Q000150:complications* / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007213:Indomethacin / Q000627:therapeutic use*; D020325:Migraine with Aura / Q000150:complications* / Q000188:drug therapy*; D051302:Paroxysmal Hemicrania / Q000150:complications* / Q000188:drug therapy*; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal; D007213:Indomethacin