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Friday, 29 November 2013

Hemicrania continua (HC) - Misdiagnosis and Diagnosis

Hemicrania continua (HC) is a chronic and persistent unilateral headache and considered as one of primary headache disorders, according to International Headache Society's International Classification(1), affecting 4 to 5% of the general population.
Misdiagnosis 
Diagnosis is difficult, in a report of a woman in her fifties, with a long history of side-locked unilateral headache, was hospitalized for left-sided side-locked paroxysmal headache (attacks with 10-20 min duration), indicated that a retrospective review of her medical history showed 15 years of unsuccessfully treated unilateral headache, until she responded completely to rofecoxib. Ipsilateral cranial autonomic symptoms also supported the diagnosis of hemicrania continua, although these symptoms presented before indomethacin was tried. Diagnostic delay and misdiagnoses of unilateral headaches, as illustrated by this case, shows the clinical controversies and difficulties in diagnosing and treating this condition.(8).
Others suggested that Misdiagnosis of HC is probably common in general neurology settings and other clinical specialties. Dr. Peres MF and the team at the UNIFESP (Universidade Federal de São Paulo), São Paulo, said "the gap between the correct and misdiagnosis of this disorder. HC was once thought to be a rare headache disorder, but is, in fact, an under-recognized headache syndrome. HC can be of continuous or remitting form. Variants such as HC with aura have been described and secondary cases may occur"(9)

Diagnosis 
many researchers believe the diagnosis of Hemicrania continua (HC) consists of the symptoms and signs of  [1]unilaterality without side shift; [2]absolute indomethacin effect; [3] and long-lasting repetitive attacks of varying duration[4], eventually with a chronic pattern, the pain being mild to severe[5](10).Other suggested clinically, HC is considered a syndrome with two pivotal characteristics: (i) strictly unilateral (moderate, fluctuating, relatively long-lasting) headache; and (ii) absolute response to indomethacin. HC is further characterized by some ancillary, but mostly "negative", features such as: (iii) relative paucity of accompaniments; and (iv) lack of precipitating factors.(11)

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Sources
(8) http://www.ncbi.nlm.nih.gov/pubmed/21494306
(9) http://www.ncbi.nlm.nih.gov/pubmed/19769451
(10) http://www.ncbi.nlm.nih.gov/pubmed/11903280
(11) http://www.ncbi.nlm.nih.gov/pubmed/11843864