Headache Associated With Internal Carotid Artery Dissection
Headache Associated With Internal Carotid Artery Dissection
Hemicrania continua (HC) is an idiopathic, chronic disorder characterized by a continuous, strictly unilateral headache associated with ipsilateral cranial autonomic symptoms. The symptoms of HC typically respond dramatically to indomethacin therapy. We describe a patient with traumatic internal carotid artery dissection, who presented with a clinical picture mimicking HC that initially responded to indomethacin. Patients with a clinical picture similar to HC should be managed with a high index of suspicion for a possible cervical arterial dissection.
Hemicrania continua (HC) is a chronic, indomethacin-responsive headache disorder characterized by a continuous, strictly unilateral head pain that fluctuates in intensity and is associated with ipsilateral cranial autonomic symptoms. HC was first described by Medina and Diamond in 1981 as a "cluster headache variant" responding to indomethacin. Sjaastad and Spierings described 2 more cases and coined the term HC. Initially considered a rare disorder, HC has been increasingly recognized over the past 2 decades. The International Headache Society (IHS) has recently published specific diagnostic criteria for HC. The rapid and dramatic response to indomethacin is a hallmark of HC, and indeed is one of the IHS diagnostic criteria for this disorder. However, the mechanism of the beneficial effect of indomethacin on HC, which far exceeds the effect of other NSAIDs on this disorder, remains unknown. Moreover, the specificity of indomethacin responsiveness for this disorder has been debated. The etiology and pathogenesis of HC are currently unknown.
We describe a patient with traumatic internal carotid artery (ICA) dissection, who presented with a clinical picture that mimicked HC, with a transient response to indomethacin.
Abstract and Introduction
Abstract
Hemicrania continua (HC) is an idiopathic, chronic disorder characterized by a continuous, strictly unilateral headache associated with ipsilateral cranial autonomic symptoms. The symptoms of HC typically respond dramatically to indomethacin therapy. We describe a patient with traumatic internal carotid artery dissection, who presented with a clinical picture mimicking HC that initially responded to indomethacin. Patients with a clinical picture similar to HC should be managed with a high index of suspicion for a possible cervical arterial dissection.
Introduction
Hemicrania continua (HC) is a chronic, indomethacin-responsive headache disorder characterized by a continuous, strictly unilateral head pain that fluctuates in intensity and is associated with ipsilateral cranial autonomic symptoms. HC was first described by Medina and Diamond in 1981 as a "cluster headache variant" responding to indomethacin. Sjaastad and Spierings described 2 more cases and coined the term HC. Initially considered a rare disorder, HC has been increasingly recognized over the past 2 decades. The International Headache Society (IHS) has recently published specific diagnostic criteria for HC. The rapid and dramatic response to indomethacin is a hallmark of HC, and indeed is one of the IHS diagnostic criteria for this disorder. However, the mechanism of the beneficial effect of indomethacin on HC, which far exceeds the effect of other NSAIDs on this disorder, remains unknown. Moreover, the specificity of indomethacin responsiveness for this disorder has been debated. The etiology and pathogenesis of HC are currently unknown.
We describe a patient with traumatic internal carotid artery (ICA) dissection, who presented with a clinical picture that mimicked HC, with a transient response to indomethacin.
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