title: Treatment of hemicrania continua: case series and literature review.
abstract: OBJECTIVE
  Hemicrania Continua (HC) is a primary, disabling headache characterized by a continuous unilateral pain and responsive to indomethacin. There are symptoms common to the trigeminal-autonomic cephalalgias and migraine that complicate the diagnosis. This review aims to describe HC in a case series and review the best available evidence on alternative therapies.
  
  
  METHODS
  A systematic review of medical records and diaries of pain of 1,600 patients treated between January 1992 and January 2011 in a headache outpatient clinic.
  
  
  RESULTS
  Ten patients with a possible diagnosis of hemicrania continua were selected; seven were diagnosed with HC according to the II International Classification of Headache Disorders. None of the patients had received the correct diagnosis before being treated at the outpatient clinic and the average time for treatment was 12 years. Prophylactic treatment was effective in 66.6% of cases with amitriptyline, 20% with gabapentin and 10% with topiramate.
  
  
  CONCLUSIONS
  HC should be considered among the diagnostic hypotheses of patients with continuous headache, with no change in neurological examination and additional tests, regardless the age of onset. The standard treatment with indomethacin (100-150mg.day(-1)) has significant risks associated with both short and long term use and may not be a good choice for continuous use. Recent studies point out possible alternatives: gabapentin, topiramate, cyclooxygenase-2 inhibitors, piroxicam, beta-cyclodextrin, amitriptyline, melatonin. Other drugs were described in different reports as efficient, but most of them were considered inefficient in other HC cases.
authors.affiliation: Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, RJ, Brazil. jnrlidia@gmail.com
authors.forename: Lídia Maria Veras Rocha de
authors.initials: LM
authors.lastname: Moura
authors.forename: José Marcelo Ferreira
authors.initials: JM
authors.lastname: Bezerra
authors.forename: Norma Regina Pereira
authors.initials: NR
authors.lastname: Fleming
mesh_terms: D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D005260:Female; D006261:Headache / Q000188:drug therapy*; D006801:Humans; D007213:Indomethacin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D007213:Indomethacin