Is there need to search for alternatives to indomethacin for hemicrania continua? Case reports and a review

• Published in: Journal of the neurological sciences Vol. 277; no. 1; pp. 187 - 190
• Main Authors: Prakash, Sanjay, Husain, Mahammed, Sureka, Dhara S, Shah, Nimish P, Shah, Nilima D
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier B.V 15.02.2009; Elsevier
• Subjects: Adult; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Anticonvulsants - therapeutic use; Autonomic nervous system; Biological and medical sciences; Fructose - analogs & derivatives; Fructose - therapeutic use; Headache Disorders - drug therapy; Hemicrania continua; Humans; Idomethacin responsive headaches; Indomethacin - therapeutic use; Indomethacin and side effects; Male; Medical sciences; Middle Aged; Neurology; Tumors of the nervous system. Phacomatoses; Indomethacin and side effects; Idomethacin responsive headaches; Hemicrania continua; Case study; Nervous system diseases; Indometacin
• ISSN: 0022-510X; 1878-5883
• DOI: 10.1016/j.jns.2008.10.027

Abstract Hemicrania continua (HC) is a daily continuous unilateral headache of moderate intensity with super imposed exacerbations of more severe pain accompanied by migrainous and cranial autonomic features. Response to indomethacin is an essential feature in the IHS diagnostic criteria. However, indomethacin is associated with a number of side effects. HC is a life long condition, and skipping of a single dose of indomethacin usually leads to reappearance of headache. Various drugs have been tried as alternatives to indomethacin in the patients intolerant to indomethacin. We report two cases of HC responsive to topiramate and review the available alternatives for the patients of HC. We also discuss the side effects of indomethacin in the various headache disorders and other painful conditions, and suggest the need for trial of other drugs for the patients of HC.