title: [A woman with unilateral headache].
abstract: A woman in her fifties, with a long history of side-locked unilateral headache, was hospitalized for left-sided side-locked paroxysmal headache (attacks with 10-20 min duration). Clinical and neurological examinations, and brain MRI revealed normal findings. She responded well to indomethacin (50 mg three times daily). Due to non-compliance because of dyspepsia, which delayed the final diagnosis of chronic paroxysmal hemicrania (CPH) for 16, months indomethacin was administered both rectally and orally. A retrospective review of her medical history showed 15 years of unsuccessfully treated unilateral headache, until she responded completely to rofecoxib. Ipsilateral cranial autonomic symptoms also supported the diagnosis of hemicrania continua, although these symptoms presented before indomethacin was tried. Diagnostic delay and misdiagnoses of unilateral headaches, as illustrated by this case, shows the clinical controversies and difficulties in diagnosing and treating this condition.
authors.affiliation: Nevrologisk avdeling, Universitetssykehuset Nord-Norge, 9038 Tromsø, Norway. kai.ivar.muller@unn.no
authors.forename: Kai Ivar
authors.initials: KI
authors.lastname: Müller
authors.forename: Svein Ivar
authors.initials: SI
authors.lastname: Bekkelund
mesh_terms: D002908:Chronic Disease; D052246:Cyclooxygenase 2 Inhibitors / Q000008:administration & dosage; D057210:Delayed Diagnosis; D003937:Diagnosis, Differential; D018450:Disease Progression; D005260:Female; D006261:Headache / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D007213:Indomethacin / Q000008:administration & dosage; D007783:Lactones / Q000008:administration & dosage; D008875:Middle Aged; D051302:Paroxysmal Hemicrania / Q000175:diagnosis* / Q000188:drug therapy; D013450:Sulfones / Q000008:administration & dosage; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D052246:Cyclooxygenase 2 Inhibitors; D007783:Lactones; D013450:Sulfones; C116926:rofecoxib; D007213:Indomethacin