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Friday, 29 November 2013

Hemicrania continua (HC)Treatments in Conventional Medicine

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.

Treatments
1. Indomethacin
Many researchers believe that Hemicrania continua is one of the indomethacin-responsive headache syndromes, patients may require daily indomethacin for years. The risks of long-term indomethacin include gastrointestinal and renal dysfunction, but according to the study from the team and Dr. JA Pareja found that Six (23%) patients showed adverse events, mostly gastrointestinal and relieved with ranitidine. No major side-effects were observed. These results indicate that prolonged indomethacin treatment of HC or CPH has a good safety and tolerability profile with a reduction of up to 60% in the initial dose.

2.  Melatonin
Other suggested that Melatonin is a pineal hormone with a chemical structure very similar to indomethacin as melatonin was shown to be effective for primary stabbing headache, another indomethacin-responsive syndrome.(12)

3.  Other studies point out possible alternatives: Gabapentin, topiramate, cyclooxygenase-2 inhibitors, piroxicam, beta-cyclodextrin, amitriptyline, melatonin. Other drugs were described in different reports as efficient, but most of them were considered inefficient in other HC cases.(13) and a report of two cases of HC responsive to topiramate and review the available alternatives for the patients of HC. The side effects of indomethacin in the various headache disorders and other painful conditions, and may need for trial of other drugs for the patients of HC.(14)

4. Etc.

Side effects
Side effects of indomethacin are not limit to
1. Indomethacin HC is a life long condition, and
2. Skipping of a single dose of indomethacin usually leads to reappearance of headache.(14)
3. risk for serious stomach/intestinal bleeding.
4. Others not common side effects include chest pain, shortness of breath, weakness on one side of the body, sudden vision changes, slurred speech.
5. Gastrointestinal and renal dysfunction.(15)
6. Etc.
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Sources
(12) http://www.ncbi.nlm.nih.gov/pubmed/16866728 
(13) http://www.ncbi.nlm.nih.gov/pubmed/22440373
(14) http://www.ncbi.nlm.nih.gov/pubmed/19041987
(15) http://www.ncbi.nlm.nih.gov/pubmed/16866728