Continuum (Minneap Minn). 2024 Apr 1;30(2):488-497. doi: 10.1212/CON.0000000000001409.
This article describes the clinical features and treatment of the indomethacin-responsive headache disorders paroxysmal hemicrania and hemicrania continua.
Both paroxysmal hemicrania and hemicrania continua are treated with indomethacin at the lowest clinically useful dose. It has recently become clear that some patients with either condition may respond to treatment with noninvasive vagus nerve stimulation, which can be both indomethacin sparing and, in some cases, headache controlling. Given the lifelong nature of both paroxysmal hemicrania and hemicrania continua, brain imaging with MRI is recommended when the conditions are identified, specifically including pituitary views.
Paroxysmal hemicrania and hemicrania continua are indomethacin-responsive headache disorders that offer a rewarding and unique opportunity to provide marked clinical improvement when recognized and treated appropriately. These disorders share the final common pathway of the trigeminal-autonomic reflex, with head pain and cranial autonomic features, and are differentiated pathophysiologically by the pattern of brain involvement, which can be seen using functional imaging. They have distinct differential diagnoses to which the clinician needs to remain alert.
本文描述了吲哚美辛反应性头痛障碍丛集性头痛和连续性偏头痛的临床特征和治疗方法。
阵发性偏头痛和连续性偏头痛均采用最低临床有效剂量的吲哚美辛治疗。最近已经清楚的是，某些具有上述两种情况的患者可能对非侵入性迷走神经刺激有反应，这可以节省吲哚美辛，并在某些情况下控制头痛。鉴于阵发性偏头痛和连续性偏头痛均为终身性疾病，当明确诊断时，建议进行 MRI 脑部成像，具体包括垂体视图。
阵发性偏头痛和连续性偏头痛是吲哚美辛反应性头痛障碍，当被识别并适当治疗时，可提供显著的临床改善，这是一种非常有价值的治疗机会。这些疾病通过三叉神经自主反射的最终共同途径共享，具有头痛和颅自主特征，并且在脑受累模式上在病理生理学上有所不同，可以通过功能成像看到。它们具有明确的鉴别诊断，临床医生需要保持警惕。
