Hartford HealthCare Headache Center, Ayer Neuroscience Institute, West Hartford.
Department of Neurology, School of Medicine, University of Connecticut, Farmington, CT.
Neurologist. 2024 Nov 1;29(6):361-364. doi: 10.1097/NRL.0000000000000583.
To report a case of hemicrania continua (HC) and persistent visual aura without infarction in a patient with previous episodic migraine with visual aura, whose persistent aura symptoms improved only after treatment with divalproex sodium.
Once regarded as highly specific for migraine, visual aura has been associated with trigeminal autonomic cephalalgias, including HC. In previous descriptions of HC and episodes of typical visual aura, the aura occurred exclusively with severe headache exacerbations and, like the pain, resolved with indomethacin.
Case report and literature review.
A 54-year-old man with a history of episodic migraine with visual aura reported a gradual onset of HC with persistent visual aura of 15 months duration. General medical and neurological examinations were normal, including imaging studies. HC's headache responded to indomethacin, while the visual aura was recalcitrant, only improving with oral divalproex sodium treatment.
As our patient experienced HC, which evolved from episodic migraine, we hypothesize that migraine and HC may share a common pathophysiology. However, the persistence of the visual aura, despite the abolition of pain and autonomic features with a therapeutic dose of indomethacin, and the subsequent successful treatment of the aura with divalproex sodium, suggest that aura and HC headache arise from distinct and dissociable mechanisms.
报告一例既往有发作性偏头痛伴视觉先兆病史的患者出现持续性偏头痛（HC）和无梗死的持续性视觉先兆，其持续性先兆症状仅在用丙戊酸钠治疗后才改善。
视觉先兆曾经被认为是偏头痛的高度特异性表现，但现已与三叉自主神经性头痛，包括 HC 有关。在之前对 HC 和典型视觉先兆发作的描述中，先兆仅在严重头痛加重时发生，且与疼痛一样，用吲哚美辛即可缓解。
病例报告和文献复习。
一名 54 岁男性，既往有发作性偏头痛伴视觉先兆病史，逐渐出现持续 15 个月的 HC 伴持续性视觉先兆。一般医学和神经系统检查均正常，包括影像学检查。HC 的头痛对吲哚美辛有反应，而视觉先兆则顽固，仅用口服丙戊酸钠治疗后才改善。
由于我们的患者经历了由发作性偏头痛演变而来的 HC，我们假设偏头痛和 HC 可能具有共同的病理生理学机制。然而，尽管用吲哚美辛的治疗剂量消除了疼痛和自主神经症状，但视觉先兆仍持续存在，随后丙戊酸钠成功治疗了先兆，这表明先兆和 HC 头痛源自不同且可分离的机制。
