Hemicrania continua responsive to verapamil

Hemicrania continua (HC) is a rare headache syndrome, typically responsive to indomethacin, although patients resistant to this drug have been described. Few treatment alternatives have been proposed in the literature. We here report a patient with HC whose initial excellent response to indomethacin faded but then responded remarkably to verapamil.     

Coexisting Trigeminal Autonomic Cephalalgias and Hemicrania Continua

The trigeminal autonomic cephalalgias (TACs) and hemicrania continua (HC) share many clinical characteristics including unilateral pain and ipsilateral autonomic features. We report a patient with a history of migraine without aura who developed cluster headache and HC simultaneously. The distinctive clinical features and differential response profiles to various treatments indicates that they are distinct disorders. We then review previous reports of patients with coexisting TACs and HC and discuss the relationship between these families of primary headache disorders.     

Chronic Paroxysmal Hemicrania: Dissociation of the Pain and Autonomic Features

The case of a woman suffering from chronic paroxysmal hemicrania is presented. Most attacks were unilateral and recurred on the same side. On a few occasions, attacks were observed on the contralateral side. In addition, the patient reported some incomplete attacks on the usually symptomatic side with autonomic phenomena, but without pain. That "partial" attacks would exist has been suspected on theoretical ground. This is, however, the first time such attacks have been reported by a patient. Therefore, a double dissociation of the symptomatology seemed to exist: (1) a side shift of attacks, and (2) incomplete("partial") attacks. These unexpected findings occurred after two indomethacin treatment withdrawals. A possible central and "midline" origin of attacks or an indomethacin after-effect or both are discussed as a likely explanation for such a dissociation of symptoms and signs.     

Nasal Sumatriptan as Adjunctive Therapy for idiopathic Trigeminal Neuralgia: Report of Three Cases

We examine the effect of nasal sumatriptan as an adjunctive therapy in 3 patients with idiopathic trigeminal neuralgia refractory to carbamazepine (CBZ) and found that this therapy might be suitable for patients for whom the CBZ dose cannot be increased, who are under poor pain control, and who are not candidates for nerve blocks or surgery.     

Episodic Paroxysmal Hemicrania: 3 New Cases and a Review of the Literature

SYNOPSIS
Episodic paroxysmal hemicrania (EPH) is a rare, benign disorder characterized by discrete bouts of hemicranial headaches separated by periods of pain-free remissions. EPH is frequently mistaken for episodic cluster headache because they have similar temporal profiles and clinical features. EPH is differentiated from cluster headaches by an increased frequency and a shorter duration of individual attacks. Establishing the diagnosis of EPH is important because of its unique response to treatment with indomethacin and not standard anti-cluster headache medications.     

LASH: a syndrome of long-lasting autonomic symptoms with hemicrania (A new indomethacin- responsive headache)

A patient presented with a unique, stereotypical, episodic headache disorder marked by long-lasting autonomic symptoms with associated hemicrania (LASH). The autonomic symptoms clearly overshadowed the headache as the major component of the syndrome. Indomethacin controlled both the autonomic symptoms and the headache, suggesting that this is a new type of indomethacin-responsive headache. It may also complete the indomethacin-responsive headache spectrum.     

Hemicrania Continua: Beneficial Effect of Non‐Invasive Vagus Nerve Stimulation in a Patient With a Contraindication for Indomethacin

Hemicrania continua (HC) is a primary chronic headache disorder, characterized by a continuous and strictly unilateral headache, with possible cranial autonomic symptoms during episodes of pain exacerbation. The unilateral headache generally responds well to indomethacin; however, continuous indomethacin intake is often not tolerated due to severe adverse effects, like hypertension, gastrointestinal discomfort (especially if combined with aspirin), slightly increased risk of vascular events, and bronchial spasms. Therefore, alternative treatment options are desperately needed. Non‐invasive vagus nerve stimulation (nVNS) has been shown to be effective in patients with cluster headache, another trigeminal autonomic cephalalgia (TAC), with cranial parasympathetic autonomic activation during the attacks.     

Comparison of High‐voltage‐ with Standard‐voltage Pulsed Radiofrequency of Gasserian Ganglion in the Treatment of Idiopathic Trigeminal Neuralgia

Although pulsed radiofrequency treatment (PRFT) has been used to treat trigeminal neuralgia (TN) safely, satisfactory improvement is lacking. Recently, much attention has been paid to the PRFT dose and intra‐operative parameters. It has been reported that high‐voltage PRFT could significantly reduce discogenic pain. However, there is no study investigating the effects of high‐voltage PRFT on TN. The aim of this prospective, randomized, double‐blinded study was to evaluate the efficacy and safety of high‐voltage PRFT in comparison with standard‐voltage PRFT for idiopathic TN. Sixty severe TN patients were randomly assigned to 2 groups treated with CT‐guided standard‐ or high‐voltage‐pulsed radiofrequency (RF) of Gasserian ganglion, respectively, between January 2012 and July 2012. Numeric Rating Scales (NRS), carbamazepine dose, and side effects were evaluated at day 1, weeks 1 and 2, months 1, 3, and 6, and 1 year postoperative. There were 27 patients in the standard‐voltage group and 26 patients in the high‐voltage group who completed the 1‐year follow‐up study. The effective rates in the standard‐voltage and high‐voltage PRFT groups were 41% and 69%, respectively, at 1, 3, and 6 months postoperative (P = 0.037). The effective rate in the standard‐voltage group decreased to 19% at 1‐year postoperative, while in the high‐voltage group remained at 69% (P = 0.000). No significant side effects were detected in both groups. In conclusion, CT‐guided high‐voltage PRFT is an effective and safe interventional therapeutic choice for idiopathic TN patients.