Cortijo Elisa, Guerrero-Peral Ángel L, Herrero-Velázquez Sonia, Mulero Patricia, Pedraza María, Barón Johanna, de la Cruz Carolina, Ruiz Marina, Campos-Blanco Dulce M, Marco-Llorente Javier, Rojo-Martínez Esther, Fernández Rosa
Servicio de Neurología. Hospital Clínico Universitario de Valladolid, Valladolid, España.
Rev Neurol. 2012 Sep 1;55(5):270-8.
Hemicrania continua is characterised by a continuous unilateral pain, which frequently gets worse in association with autonomic symptoms. It is probably little known and underdiagnosed. Its diagnosis requires a response to indomethacin, which is not always well tolerated.
We report a series of 36 cases of hemicrania continua that were treated in the headache service of a tertiary hospital. We analyse their demographic and clinical features and the therapeutic alternatives to indomethacin.
Between January 2008 and April 2012, 36 patients (28 females, eight males) were diagnosed with hemicrania continua from among 1800 (2%) who were treated in that service.
The age of onset was 46.3 ± 18.4 years. In four patients (11.1%) there were pain remissions that lasted over three months. The baseline pain was chiefly oppressive or burning with an intensity of 5.2 ± 1.4 on the verbal analogue scale. Exacerbations lasted 32.3 ± 26.1 minutes, were of a predominantly stabbing nature with an intensity of 8.3 ± 1.4, and in 69.4% of cases were accompanied by autonomic symptoms. Altogether 16.7% of the patients did not tolerate indomethacin beyond an indotest and 50% did so with side effects. In 13 cases at least one anaesthetic blockade was performed in the supraorbital or the greater occipital nerve or a trochlear injection of corticoids was carried out with a full response in 53.8% and a partial response in 38.5%.
Hemicrania continua is not an infrequent diagnosis in a headache clinic and, because it is a treatable condition, further knowledge on the subject is needed. Anaesthetic blockades of the supraorbital or greater occipital nerves or a trochlear injection of corticoids are the therapeutic options that must be taken into consideration when indomethacin is not well tolerated.
持续性偏侧头痛的特征为单侧持续性疼痛，常伴有自主神经症状加重。该病可能鲜为人知且诊断不足。其诊断需要对吲哚美辛有反应，但吲哚美辛的耐受性并不总是很好。
我们报告了在一家三级医院头痛门诊治疗的36例持续性偏侧头痛病例。我们分析了其人口统计学和临床特征以及吲哚美辛的替代治疗方法。
2008年1月至2012年4月期间，在该门诊接受治疗的1800名患者（占2%）中，有36例（28名女性，8名男性）被诊断为持续性偏侧头痛。
发病年龄为46.3±18.4岁。4例患者（11.1%）出现了持续超过3个月的疼痛缓解。基线疼痛主要为压迫性或灼痛，视觉模拟量表评分为5.2±1.4。发作持续32.3±26.1分钟，主要为刺痛性质，强度为8.3±1.4，69.4%的病例伴有自主神经症状。共有16.7%的患者在进行吲哚美辛激发试验后无法耐受吲哚美辛，50%的患者出现副作用。13例患者至少进行了一次眶上神经或枕大神经麻醉阻滞，或进行了滑车神经皮质类固醇注射，完全缓解率为53.8%，部分缓解率为38.5%。
在头痛门诊中，持续性偏侧头痛并非罕见的诊断，由于它是一种可治疗的疾病，因此需要对该主题有更多的了解。当吲哚美辛耐受性不佳时，眶上神经或枕大神经麻醉阻滞或滑车神经皮质类固醇注射是必须考虑的治疗选择。
