Abstract：
Hemicrania continua is a primary unilateral headache characterized by ipsilateral parasympathetic and sympathetic autonomic features. A key diagnostic criterion is its dramatic response to indomethacin treatment; however, various vascular or structural abnormalities have been reported to cause secondary hemicrania continua, presenting with clinical features similar to those of the primary headache presentation.
We reviewed the literature to compile secondary hemicrania continua cases, highlighting the importance of imaging during the evaluation. Additionally, we also contributed our three cases to the existing studies.
We conducted a review of articles from the PubMed and EMBASE databases that described reported cases of secondary hemicrania continua, covering the period from 1993 to 2021. Our review included detailed patient information, signs, and symptoms of hemicrania continua, as well as information on indomethacin usage and headache resolution (if pertinent).
Secondary hemicrania continua can result from a remarkably diverse range of structural and vascular lesions, yet clinical reports on long-term follow-up are lacking. Notably, cases may exhibit a classical response to indomethacin, emphasizing the importance of neuroimaging in excluding secondary cases. Our search yielded 41 cases meeting our criteria. We excluded six cases that were not treated with indomethacin or were unresponsive to it. Additionally, we present three cases that highlight the necessity of neuroimaging in evaluating hemicrania continua, along with short- and long-term clinical outcomes following indomethacin and lesion-directed treatments. Case 1 presented with daily right-sided headaches and cranial autonomic symptoms. Her pain completely resolved with indomethacin use. Neuroimaging of the brain revealed a laterally directed saccular aneurysm of the right internal carotid artery. Case 2 presented with continuous left-sided unilateral headaches with superimposed exacerbations. She complained of left-sided photophobia with a dull sensation in the left ear. Her symptoms decreased after 2 weeks of indomethacin use. Neuroimaging of the head indicated a benign tumor with mass effect into the left lateral medulla and inferior cerebellar peduncle. Case 3 presented with a right side-locked headache with daily, severe superimposed exacerbations. She had photophobia in the right eye and a right-sided Horner\'s syndrome, along with tearing during her exacerbations. Neuroimaging of the brain revealed a pituitary tumor and her pain completely resolved with indomethacin.
Hemicrania continua is a rare headache disorder that can be either primary or secondary. Importantly, response to indomethacin can still occur in secondary hemicrania continua. Thus, neuroimaging should be considered to rule out underlying structural etiology in all cases, regardless of their clinical responsiveness to indomethacin therapy.
We reviewed the literature to compile secondary hemicrania continua cases, highlighting the importance of imaging during the evaluation. Additionally, we also contributed our three cases to the existing studies.
We conducted a review of articles from the PubMed and EMBASE databases that described reported cases of secondary hemicrania continua, covering the period from 1993 to 2021. Our review included detailed patient information, signs, and symptoms of hemicrania continua, as well as information on indomethacin usage and headache resolution (if pertinent).
Secondary hemicrania continua can result from a remarkably diverse range of structural and vascular lesions, yet clinical reports on long-term follow-up are lacking. Notably, cases may exhibit a classical response to indomethacin, emphasizing the importance of neuroimaging in excluding secondary cases. Our search yielded 41 cases meeting our criteria. We excluded six cases that were not treated with indomethacin or were unresponsive to it. Additionally, we present three cases that highlight the necessity of neuroimaging in evaluating hemicrania continua, along with short- and long-term clinical outcomes following indomethacin and lesion-directed treatments. Case 1 presented with daily right-sided headaches and cranial autonomic symptoms. Her pain completely resolved with indomethacin use. Neuroimaging of the brain revealed a laterally directed saccular aneurysm of the right internal carotid artery. Case 2 presented with continuous left-sided unilateral headaches with superimposed exacerbations. She complained of left-sided photophobia with a dull sensation in the left ear. Her symptoms decreased after 2 weeks of indomethacin use. Neuroimaging of the head indicated a benign tumor with mass effect into the left lateral medulla and inferior cerebellar peduncle. Case 3 presented with a right side-locked headache with daily, severe superimposed exacerbations. She had photophobia in the right eye and a right-sided Horner\'s syndrome, along with tearing during her exacerbations. Neuroimaging of the brain revealed a pituitary tumor and her pain completely resolved with indomethacin.
Hemicrania continua is a rare headache disorder that can be either primary or secondary. Importantly, response to indomethacin can still occur in secondary hemicrania continua. Thus, neuroimaging should be considered to rule out underlying structural etiology in all cases, regardless of their clinical responsiveness to indomethacin therapy.
摘要：
背景：连续性偏头痛是一种以同侧副交感神经和交感神经自主神经特征为特征的原发性单侧头痛。一个关键的诊断标准是它对消炎痛治疗的巨大反应；然而，据报道，各种血管或结构异常会导致继发性偏头痛，表现出与原发性头痛相似的临床特征。
目的：我们回顾了文献以汇编继发性连续性偏头痛病例，强调评估过程中成像的重要性。此外,我们还为现有研究贡献了三个案例。
方法：我们对PubMed和EMBASE数据库中的文章进行了综述，这些文章描述了继发性连续性偏头痛的报告病例，涵盖1993年至2021年期间。我们的审查包括详细的患者信息，标志,和连续性偏头痛的症状，以及吲哚美辛使用和头痛解决的信息（如果相关）。
结果：继发性连续性偏头痛可由不同范围的结构和血管病变引起，然而缺乏长期随访的临床报告.值得注意的是,病例可能表现出对消炎痛的经典反应，强调神经影像学在排除继发性病例中的重要性。我们的搜索产生了41例符合我们标准的病例。我们排除了6例未接受消炎痛治疗或对消炎痛无反应的病例。此外,我们提出了三个案例，强调神经影像学在评估连续性偏头痛中的必要性，以及吲哚美辛和病变导向治疗后的短期和长期临床结局。病例1表现为每日右侧头痛和颅骨自主神经症状。她的疼痛完全消除与消炎痛的使用。大脑的神经影像学显示右颈内动脉的侧向囊状动脉瘤。病例2表现为持续的左侧单侧头痛，并伴有加重。她抱怨左侧畏光，左耳感觉暗淡。使用消炎痛2周后，她的症状有所减轻。头部神经影像学显示良性肿瘤，具有进入左外侧延髓和小脑下脚的肿块效应。病例3表现为右侧锁定性头痛，每天，严重叠加恶化。她有右眼畏光和右侧霍纳综合征,随着她恶化期间的撕裂。大脑的神经影像学显示垂体肿瘤，吲哚美辛完全缓解了她的疼痛。
结论：连续性偏头痛是一种罕见的头痛疾病，可以是原发性或继发性。重要的是,对吲哚美辛的反应仍可发生在继发性偏头痛连续性中。因此，在所有病例中，应考虑神经影像学以排除潜在的结构性病因，无论他们对消炎痛治疗的临床反应。
目的：我们回顾了文献以汇编继发性连续性偏头痛病例，强调评估过程中成像的重要性。此外,我们还为现有研究贡献了三个案例。
方法：我们对PubMed和EMBASE数据库中的文章进行了综述，这些文章描述了继发性连续性偏头痛的报告病例，涵盖1993年至2021年期间。我们的审查包括详细的患者信息，标志,和连续性偏头痛的症状，以及吲哚美辛使用和头痛解决的信息（如果相关）。
结果：继发性连续性偏头痛可由不同范围的结构和血管病变引起，然而缺乏长期随访的临床报告.值得注意的是,病例可能表现出对消炎痛的经典反应，强调神经影像学在排除继发性病例中的重要性。我们的搜索产生了41例符合我们标准的病例。我们排除了6例未接受消炎痛治疗或对消炎痛无反应的病例。此外,我们提出了三个案例，强调神经影像学在评估连续性偏头痛中的必要性，以及吲哚美辛和病变导向治疗后的短期和长期临床结局。病例1表现为每日右侧头痛和颅骨自主神经症状。她的疼痛完全消除与消炎痛的使用。大脑的神经影像学显示右颈内动脉的侧向囊状动脉瘤。病例2表现为持续的左侧单侧头痛，并伴有加重。她抱怨左侧畏光，左耳感觉暗淡。使用消炎痛2周后，她的症状有所减轻。头部神经影像学显示良性肿瘤，具有进入左外侧延髓和小脑下脚的肿块效应。病例3表现为右侧锁定性头痛，每天，严重叠加恶化。她有右眼畏光和右侧霍纳综合征,随着她恶化期间的撕裂。大脑的神经影像学显示垂体肿瘤，吲哚美辛完全缓解了她的疼痛。
结论：连续性偏头痛是一种罕见的头痛疾病，可以是原发性或继发性。重要的是,对吲哚美辛的反应仍可发生在继发性偏头痛连续性中。因此，在所有病例中，应考虑神经影像学以排除潜在的结构性病因，无论他们对消炎痛治疗的临床反应。
