Fundación Alcorcón University Hospital, Alcorcón, Madrid, Spain.
Cephalalgia. 2012 Apr;32(5):413-8. doi: 10.1177/0333102412441088. Epub 2012 Mar 9.
Hemicrania continua was originally described as a strictly unilateral, continuous headache with an absolute response to indomethacin. Recognition of an increasing number of patients with the same clinical features except for a lack of response to indomethacin has generated controversy about whether the responsive/non-responsive phenotypes belong to the same disorder.
We suggest that the non-responsive phenotype should be differentiated from the original concept of hemicrania continua, because it probably indicates a separate type of headache of undetermined nature, i.e. hemicrania incerta. However, differentiating hemicrania incerta from hemicrania continua does not imply that the two headaches are unrelated. Both hemicranias may outline a continuum, giving rise to a broader diagnostic field.
There seems to be a syndrome of 'primary continuous unilateral headache' with at least two distinctive categories: hemicrania continua and hemicrania incerta, which are differentiated by their respective response to indomethacin. This division means plurality but adds precision, and allows a clear-cut diagnosis of some controversial cases.
慢性偏头痛最初被描述为一种严格单侧、持续的头痛，对吲哚美辛有绝对的反应。然而，越来越多的患者表现出相同的临床特征，但对吲哚美辛没有反应，这引发了争议，即有反应/无反应表型是否属于同一疾病。
我们建议将无反应表型与慢性偏头痛的原始概念区分开来，因为它可能表明是一种性质不明的单独类型的头痛，即不确定型偏头痛。然而，将不确定型偏头痛与慢性偏头痛区分开来并不意味着这两种头痛没有关联。两者可能都勾勒出一个连续统，从而产生一个更广泛的诊断领域。
似乎存在一种“原发性持续性单侧头痛”综合征，至少有两个不同的类别：慢性偏头痛和不确定型偏头痛，它们通过对吲哚美辛的反应来区分。这种划分意味着多样性，但增加了准确性，并允许对一些有争议的病例进行明确诊断。
