ABSTRACT
This paper will discuss evidence which supports a link between 'side locked' migraine (SLM) and the trigeminal autonomic cephalgias (TACs). Recent papers brought strictly unilateral primary headaches into focus, proposing new classification and discussing pathophysiological mechanisms. We reviewed those proposals and present evidence that SLM falls in between the well-defined TACs and side shifting migraine (SSM). It is difficult to differentiate SLM from the recently proposed headache subtype called hemicrania generis incerti (i.e. hemicrania continua unresponsive to indomethacin). We also present cases that may exemplify the considerations made in the paper.
Subject(s)
Autonomic Nervous System Diseases/diagnosis , Migraine Disorders/diagnosis , Trigeminal Neuralgia/diagnosis , Animals , Autonomic Nervous System Diseases/classification , Autonomic Nervous System Diseases/physiopathology , Brain/blood supply , Humans , Migraine Disorders/classification , Migraine Disorders/physiopathology , Reflex, Abnormal/physiology , Trigeminal Neuralgia/classification , Trigeminal Neuralgia/physiopathology , Vasodilation/physiologyABSTRACT
Episodic paroxysmal hemicrania (EPH) is a rare disorder characterized by frequent, daily attacks of short-lived, unilateral headache with accompanying ipsilateral autonomic features. EPH has attack periods which last weeks to months separated by remission intervals lasting months to years, however, a seasonal variation has never been reported in EPH. We report a new case of EPH with a clear seasonal pattern: a 32-year-old woman with a right-sided headache for 17 years. Pain occurred with a seasonal variation, with bouts lasting one month (usually in the first months of the year) and remission periods lasting around 11 months. During these periods she had headache from three to five times per day, lasting from 15 to 30 minutes, without any particular period preference. There were no precipitating or aggravating factors. Tearing and conjunctival injection accompanied ipsilaterally the pain. Previous treatments provided no pain relief. She completely responded to indomethacin 75 mg daily. After three years, the pain recurred with longer attack duration and was just relieved with prednisone. We also propose a new hypothesis: the EPH-cluster headache continuum.
Subject(s)
Cluster Headache/physiopathology , Migraine Disorders/physiopathology , Adult , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Cluster Headache/diagnosis , Cluster Headache/drug therapy , Female , Humans , Indomethacin/therapeutic use , Migraine Disorders/diagnosis , Migraine Disorders/drug therapyABSTRACT
The association of chronic paroxysmal hemicrania and ticlike pain-chronic paroxysmal hemicrania-tic (CPH-tic)-is a recently described syndrome. The authors found only two previously reported cases. They report three new cases of this rare syndrome with both chronic paroxysmal hemicrania and ticlike pain concurrently and ipsilaterally. The trigeminal-autonomic cephalalgias (TAC) are considered as differential diagnoses. CPH-tic syndrome could be a different clinical entity.