title: [Hemicrania continua: characteristics and therapeutic experience in a series of 36 patients].
abstract: BACKGROUND
  Hemicrania continua is characterised by a continuous unilateral pain, which frequently gets worse in association with autonomic symptoms. It is probably little known and underdiagnosed. Its diagnosis requires a response to indomethacin, which is not always well tolerated.
  
  
  OBJECTIVE
  We report a series of 36 cases of hemicrania continua that were treated in the headache service of a tertiary hospital. We analyse their demographic and clinical features and the therapeutic alternatives to indomethacin.
  
  
  METHODS
  Between January 2008 and April 2012, 36 patients (28 females, eight males) were diagnosed with hemicrania continua from among 1800 (2%) who were treated in that service.
  
  
  RESULTS
  The age of onset was 46.3 ± 18.4 years. In four patients (11.1%) there were pain remissions that lasted over three months. The baseline pain was chiefly oppressive or burning with an intensity of 5.2 ± 1.4 on the verbal analogue scale. Exacerbations lasted 32.3 ± 26.1 minutes, were of a predominantly stabbing nature with an intensity of 8.3 ± 1.4, and in 69.4% of cases were accompanied by autonomic symptoms. Altogether 16.7% of the patients did not tolerate indomethacin beyond an indotest and 50% did so with side effects. In 13 cases at least one anaesthetic blockade was performed in the supraorbital or the greater occipital nerve or a trochlear injection of corticoids was carried out with a full response in 53.8% and a partial response in 38.5%.
  
  
  CONCLUSIONS
  Hemicrania continua is not an infrequent diagnosis in a headache clinic and, because it is a treatable condition, further knowledge on the subject is needed. Anaesthetic blockades of the supraorbital or greater occipital nerves or a trochlear injection of corticoids are the therapeutic options that must be taken into consideration when indomethacin is not well tolerated.
authors.affiliation: Servicio de Neurología. Hospital Clínico Universitario de Valladolid, Valladolid, España.
authors.forename: Elisa
authors.initials: E
authors.lastname: Cortijo
authors.forename: Ángel L
authors.initials: ÁL
authors.lastname: Guerrero-Peral
authors.forename: Sonia
authors.initials: S
authors.lastname: Herrero-Velázquez
authors.forename: Patricia
authors.initials: P
authors.lastname: Mulero
authors.forename: María
authors.initials: M
authors.lastname: Pedraza
authors.forename: Johanna
authors.initials: J
authors.lastname: Barón
authors.forename: Carolina
authors.initials: C
authors.lastname: de la Cruz
authors.forename: Marina
authors.initials: M
authors.lastname: Ruiz
authors.forename: Dulce M
authors.initials: DM
authors.lastname: Campos-Blanco
authors.forename: Javier
authors.initials: J
authors.lastname: Marco-Llorente
authors.forename: Esther
authors.initials: E
authors.lastname: Rojo-Martínez
authors.forename: Rosa
authors.initials: R
authors.lastname: Fernández
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use; D002045:Bupivacaine; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007213:Indomethacin / Q000009:adverse effects / Q000627:therapeutic use; D007267:Injections; D008279:Magnetic Resonance Imaging; D008297:Male; D008619:Mepivacaine; D008875:Middle Aged; D008881:Migraine Disorders / Q000188:drug therapy* / Q000453:epidemiology; D009407:Nerve Block; D009882:Ophthalmic Nerve; D063189:Symptom Assessment; D014221:Triamcinolone / Q000008:administration & dosage / Q000627:therapeutic use; D014321:Trochlear Nerve; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D014221:Triamcinolone; D008619:Mepivacaine; D007213:Indomethacin; D002045:Bupivacaine