title: Hemicrania continua may respond to repetitive sphenopalatine ganglion block: A case report.
abstract: BACKGROUND
  Hemicrania continua (HC) is a chronic headache disorder characterized by a continuous, strictly unilateral head pain accompanied by cranial autonomic symptoms, which completely responds to indomethacin; however, few alternative treatment options exist for the patients with this disorder who cannot tolerate indomethacin. Sphenopalatine ganglion (SPG) block has been used for the treatment of various headaches, with the strongest evidence for efficacy in cluster headache.
  
  
  METHODS
  A 52-year-old woman with a 7-year history of HC was evaluated in our clinic for management of her headaches after she had stopped using indomethacin due to a bleeding gastrointestinal ulcer. After failing multiple pharmacologic therapies, she was treated with repetitive SPG blocks using bupivacaine (0.6 mL at 0.5%) twice a week for 6 weeks and followed by maintenance therapy. This treatment protocol resulted in significant improvement in her headaches, mood, and functional capacity.
  
  
  CONCLUSIONS
  SPG block using a local anesthetic may be an effective treatment for patients with HC, specifically for those who cannot tolerate indomethacin, or when this drug is contraindicated.
authors.affiliation: School of Medicine, Department of Neurology, University of South Carolina, Columbia, SC, USA.
authors.forename: X Michelle
authors.initials: XM
authors.lastname: Androulakis
authors.affiliation: School of Medicine, Department of Neurology, University of South Carolina, Columbia, SC, USA.
authors.forename: Kaitlin A
authors.initials: KA
authors.lastname: Krebs
authors.affiliation: Department of Medicine (Neurology), Doylestown Hospital, Doylestown, PA, USA.
authors.forename: Avi
authors.initials: A
authors.lastname: Ashkenazi
mesh_terms: D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation* / Q000379:methods; D051302:Paroxysmal Hemicrania / Q000188:drug therapy*; D059387:Sphenopalatine Ganglion Block / Q000295:instrumentation* / Q000379:methods*
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine
keywords: chronic migraine; cranial autonomic symptoms; hemicrania continua; indomethacin; sphenopalatine ganglion block; trigeminal autonomic cephalagias