Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942012000200004
Brazilian Journal of Anesthesiology
Scientific Article

Tratamento da hemicrania contínua: série de casos e revisão da literatura

Treatment of hemicrania continua: case series and literature review

Lídia Maria Veras Rocha de Moura; José Marcelo Ferreira Bezerra; Norma Regina Pereira Fleming

http://dx.doi.org/10.1590/S0034-70942012000200004 Braz J Anesthesiol, vol.62, n2, p.180-187, 2012
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Resumo

JUSTIFICATIVA E OBJETIVOS: A Hemicrania Contínua (HC) é uma cefaleia primária, incapacitante, caracterizada por dor contínua, unilateral e responsiva à indometacina. Existem sintomas comuns às cefaleias trigêmino-autonômicas e à migrânea, que dificultam o diagnóstico. A presente revisão busca descrever a HC em uma série de casos e analisar as melhores evidências disponíveis sobre alternativas terapêuticas. MÉTODOS: Revisão sistemática dos prontuários e dos diários de dor de 1.600 pacientes, atendidos entre janeiro de 1992 e janeiro de 2011 em um ambulatório de cefaleia. RESULTADOS: Dez pacientes com possível diagnóstico de Hemicrania Contínua foram selecionados; sete receberam diagnóstico de HC segundo a II Classificação Internacional das Cefaleias. Nenhum paciente havia recebido o diagnóstico correto antes de ser atendido no ambulatório e o tempo médio para o mesmo foi de 12 anos. A amitriptilina foi eficaz no tratamento profilático de 66,6% dos casos, a gabapentina em 20% e o topiramato em 10%. CONCLUSÕES: A HC deve ser considerada entre as hipóteses diagnósticas de pacientes com cefaleia contínua, sem alterações ao exame neurológico e exames subsidiários, independentemente da idade do surgimento. O tratamento usual, 100 mg a 150 mg diários de indometacina, possui riscos relevantes associados ao uso a curto e longo prazos e pode não ser boa escolha para uso contínuo. Estudos recentes apontam possíveis alternativas: gabapentina, topiramato, inibidores da ciclooxigenase-2, piroxican betaciclodextrina, amitriptilina e melatonina. Outras drogas foram descritas como eficazes em relatos isolados, mas a maioria foi considerada ineficaz em outros casos de HC.

Palavras-chave

DOENÇAS, DOR, DOR, TÉCNICAS DE ANALGESIA

Abstract

BACKGROUND AND OBJECTIVES: Hemicrania Continua (HC) is a primary, disabling headache characterized by a continuous unilateral pain and responsive to indomethacin. There are symptoms common to the trigeminal-autonomic cephalalgias and migraine that complicate the diagnosis. This review aims to describe HC in a case series and review the best available evidence on alternative therapies. METHOD: A systematic review of medical records and diaries of pain of 1,600 patients treated between January 1992 and January 2011 in a headache outpatient clinic. RESULTS: Ten patients with a possible diagnosis of hemicrania continua were selected; seven were diagnosed with HC according to the II International Classification of Headache Disorders. None of the patients had received the correct diagnosis before being treated at the outpatient clinic and the average time for treatment was 12 years. Prophylactic treatment was effective in 66.6% of cases with amitriptyline, 20% with gabapentin and 10% with topiramate. CONCLUSIONS: HC should be considered among the diagnostic hypotheses of patients with continuous headache, with no change in neurological examination and additional tests, regardless the age of onset. The standard treatment with indomethacin (100-150 mg.day-1) has significant risks associated with both short and long term use and may not be a good choice for continuous use. Recent 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.

Keywords

Analgesia, Chronic Pain, Headache, Therapeutics

References

Sjaastad O. Chronic paroxysmal hemicrania, hemicrania continua and SUNCT: the fate of the three first described cases. J Headache Pain. 2006;7:151-156.

Silberstein SD, Peres MFP. Hemicrania continua. Arch Neurol. 2002;59:1029-1030.

Pareja JA, Antonaci F, Vicent M. The hemicrania continua diagnosis. Cephalagia. 2001;21:940-946.

Rossi P, Tassorelli C, Allena M, Ferrante E, Lisotto C, Nappi G. Focus on therapy: hemicrania continua and new daily persistent Headache. J Headache Pain. 2010;11(3):259-265.

Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Cephalalgia. 2004;24(^s1):1-160.

Silberstein SD, Lipton RB, Sliwinski M. Classification of daily and near-daily headaches: field trial of revised IHS criteria. Neurology. 1996;47:871-875.

Silberstein SD. Chronic Daily Headache. JAOA. 2005;105(^s2):23-29.

Peres MFP, Silberstein SD, Nahmias S. Hemicrania continua is not that rare. Neurology. 2001;57:948-951.

Baldacci F, Nuti A, Cafforio G. INDOTEST in atypical hemicrania continua. Cephalalgia. 2008;28(3):300-301.

Amaral V, De Freitas GR, Rodrigue BCB. Patent foramen ovale in trigeminal autonomic cephalalgias and hemicrania continua: a non-specific pathophysiological occurrence?. Arq Neuropsiquiatr. 2010;68(4):627-631.

Lay CL, Newman LC. Posttraumatic Hemicrania Continua. Headache. 1999;39:275-279.

Rapoport AM, Bigal ME. Hemicrania continua: clinical and nosographic update. Neurol Sci. 2003;24:S118-S121.

Trucco M, Mainardi F, Maggioni F, Badino F, Zanchin G. Chronic paroxysmal hemicrania, hemicrania continua and SUNCT syndrome in association with other pathologies: a review. Cephalalgia. 2004;24:173-184.

Vikelis M, Xifaras M, Magoufis G, Gekas G, Mitsikostas DD. Headache attributed to unruptured saccular aneurysm, mimicking hemicrania continua. J Headache Pain. 2005;6:156-158.

Taub D, Stiles A, Tucke AG. Hemicrania continua presenting as temporomandibular joint pain. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;105:e35-e37.

Cittadini E, Matharu MS. Symptomatic trigeminal autonomic cephalalgias. Neurologist. 2009;15(6):305.

Goadsby PJ, Cittadini E, Burns B, Cohen AS. Trigeminal autonomic cephalalgias: diagnostic and therapeutic developments. Curr Opin Neurol. 2008;21:323-330.

Allena M, Tassorelli C, Sances G. Is hemicrania continua a single entity or the association of two headache forms?: Considerations from a case report. Headache. 2010;50(5):877-881.

Matharu MS, Cohen AS, McGonigle DJ, Ward N, Frackowiak RS, Goasdby PJ. Posterior Hyphotalamic and Brainstem Activation in Hemicrania Continua. Headache. 2004;44(8):747-761.

Cittadini E, Goadsby PJ. Hemicrania continua: a clinical study of 39 patients with diagnostic implications. Brain. 2010;133:1973-1986.

Fragoso YD, Machado PC. Hemicrania Continua. J Pediatr. 1999;75(3):201-203.

Sjaastad O, Bakketeig LS. The rare, unilateral headaches: Vågå study of headache epidemiology. J Headache Pain. 2007;8:19-27.

Sandrini G, Tassorelli C, Ghiotto N, Nappi G. Uncommon primary headaches. Curr Opin Neurol. 2006;19:299-304.

Rapoport AM, Bigal ME. Hemicrania continua. J Headache Pain. 2004;5:S96-S98.

Yablon LA, Newman LC. Hemicrania continua: a second case in which the remitting form evolved from the chronic form. Headache. 2010;50:1381-1389.

Antonaci F, Pareja JA, Caminero AB, Sjaastad O. Chronic paroxysmal hemicrania and hemicrania continua: Parenteral indomethacin: the indotest. Headache. 1998;38(2):122-128.

Bigal ME, Tepper SJ, Sheftell FD, Rapoport AM. Hemicrania continua: a report of ten new cases. Arq. Neuropsiquiatr. 2002;60(3):695-698.

Cosentino G, Fierro B, Puma AR, Talamanca S, Brighina F. Different forms of trigeminal autonomic cephalalgias in the same patient: description of a case. J Headache Pain. 2010;11:281-284.

Terlizzi R, Cevoli S, Nicodemo M, Pierangeli G, Grimaldi D, Cortelli P. A case of strictly unilateral migraine without aura transformed in an episodic hemicrania continua. Neurol Sci. 2011;32(1):169-170.

Prakash S, Shah ND, Bhanvadia RJ. Hemicrania continua unresponsive or partially responsive to indomethacin: does it exist? A diagnostic and therapeutic dilemma. J Headache Pain. 2009;10(1):59-63.

Marmura MJ, Silberstein SD, Gupta M. Hemicrania continua: who responds to indomethacin?. Cephalalgia. 2008;29:300-307.

Rossi P, Faroni J, Tassorelli C, Nappi G. Diagnostic Delay and Suboptimal Management in a Referral Population With Hemicrania Continua. Headache. 2009;49(2):227-234.

Pareja JA, Sjaastad O. Chronic paroxysmal hemicrania and hemicrania continua: Interval between indomethacin administration and response. Headache. 1996;36:20-23.

Pareja JA, Caminero AB, Franco E, Casado JL, Pascual J, Del Río MS. Dose, efficacy and tolerability of long-term indomethacin treatment of chronic paroxysmal hemicrania and hemicrania continua. Cephalalgia. 2001;21:906-910.

Spears RC. Is gabapentin an effective treatment choice for hemicrania continua?. J Headache Pain. 2009;10(4):271-275.

Camarda C, Camarda R, Monastero R. Chronic paroxysmal hemicrania and hemicranias continua responding to topiramate: two case reports. Clin Neurol Neurosurg. 2008;110:88-91.

Prakash S, Husain M, Sureka DS, Shah NP, Shah ND. Is there need to search for alternatives to indomethacin for hemicrania continua?: Case reports and a review. J Neurol Sci. 2009;277:187-190.

Redillas C, Silomon S. Prophylatic phamacological treatment of chronic daily headache. Headache. 2000;40:83-102.

Robbins MS, Grosberg BM, Lipton RB. Coexisting trigeminal autonomic cephalalgias and hemicrania continua. Headache. 2010;50(3):489-496.

Peres MF, Silberstein SD. Hemicrania continua responds to cyclooxygenase-2 inhibitors. Headache. 2002;42:530-531.

Jüni P, Nartey L, Reichenbach S, Sterchi R, Dieppe PA, Egger M. Risk of cardiovascular events and rofecoxib: cumulative meta-analysis. The Lancet. 2004;364(9450):2021-2029.

Sjaastad O, Antonaci F. A piroxicam derivative partly effective in chronic paroxysmal hemicrania and hemicranias continua. Headache. 1995;35:549-550.

Rozen TD. Trigeminal autonomic cephalalgias. Neurol Clin. 2009;27:537-556.

Rozen TD. Melatonin responsive hemicrania continua. Headache. 2006;46:1203-1204.

Spears RC. Hemicrania continua: a case in which a patient experienced complete relief on melatonin. Headache. 2006;46:524-527.

Garza I, Cutrer FM. Pain relief and persistence of dysautonomic features in a patient with hemicrania continua responsive to botulinum toxin type A. Cephalalgia. 2010;30:500-503.

Burns B, Watkins L, Goadsby PJ. Treatment of hemicrania continua by occipital nerve stimulation with a bion device: long-term follow-up of a crossover study. Lancet Neurol. 2008;7(11):1001-1012.

Wilbrink LA, Ferrari MD, Kruit MC, Haana J. åNeuroimaging in trigeminal autonomic cephalgias: when, how, and of what?. Curr Opin Neurol. 2009;22(3):247-253.

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