title: Hemicrania continua changed to chronic paroxysmal hemicrania after treatment with cyclooxygenase-2 inhibitor.
abstract: Remission of hemicrania continua (HC) and transformation from HC to chronic paroxysmal hemicrania (CPH) are unusual. We report a patient with left-sided HC who, after a period of remission, presented as CPH. The continuous HC headache disappeared completely after initiating treatment with cyclooxygenase (COX)-2 inhibitor, but reappeared on the same side after 14 months remission with paroxysmal, frequent, intense and short-lasting headache attacks accompanied by ipsilateral cranial autonomic symptoms. This happened shortly after the treatment was discontinued because of withdrawal of the COX-2 inhibitor from the market. The response to indomethacin was prompt, and the patient became completely free from her paroxysmal headache with a dose of 50 mg 2 times daily. This case questions a possible modification effect on the course of HC by use of COX-2 inhibitor, as well as further supporting that some aspects of the pathophysiology of HC may resemble those of CPH, and may argue for common biological mechanisms in HC and CPH.
authors.affiliation: Department of Neurology, the University hospital of North Norway, Tromsø, Norway.
authors.forename: Kai Ivar
authors.initials: KI
authors.lastname: Müller
authors.forename: Svein Ivar
authors.initials: SI
authors.lastname: Bekkelund
mesh_terms: D052246:Cyclooxygenase 2 Inhibitors / Q000627:therapeutic use*; D005260:Female; D006261:Headache / Q000188:drug therapy*; D006801:Humans; D007213:Indomethacin / Q000627:therapeutic use; D007783:Lactones / Q000627:therapeutic use; D008875:Middle Aged; D051302:Paroxysmal Hemicrania / Q000188:drug therapy*; D013450:Sulfones / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D052246:Cyclooxygenase 2 Inhibitors; D007783:Lactones; D013450:Sulfones; C116926:rofecoxib; D007213:Indomethacin