[Hemicrania continua: characteristics and therapeutic experience in a series of 36 patients].

Introduction: 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.
Aims: 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.
Patients and 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.