Indomethacin-induced de novo headache in hemicrania continua--fighting fire with fire?

TY - JOUR

T1 - Indomethacin-induced de novo headache in hemicrania continua--fighting fire with fire?

AU - Jürgens, Tim P

AU - Schulte, Laura H

AU - May, Arne

N1 - Editorial

PY - 2013/10/1

Y1 - 2013/10/1

N2 - INTRODUCTION: The response to indomethacin is an important feature for the diagnosis of hemicrania continua.CASE DESCRIPTION: We report the case of a 34-year-old female patient with a one-year history of strictly unilateral continuous headache with accompanying ipsilateral autonomic symptoms. As diagnostic testing was unremarkable, hemicrania continua was suspected. A dose of 150 mg of indomethacin/day reduced the headache by 80%. Although an increase to 225 mg/day led to a further reduction of headaches, a new onset of moderate to severe pulsating migrainous bilateral headache developed.DISCUSSION: As shown in older studies, indomethacin can induce de novo headaches in a presumably dose-related fashion although the exact mechanism in uncertain. A treatable secondary origin of the indomethacin-induced headaches in patients with hemicrania continua or paroxysmal hemicrania (such as reversible cerebral vasoconstriction syndrome or aseptic meningitis) should be considered and excluded by further diagnostic testing if headaches persist after discontinuation of indomethacin.

AB - INTRODUCTION: The response to indomethacin is an important feature for the diagnosis of hemicrania continua.CASE DESCRIPTION: We report the case of a 34-year-old female patient with a one-year history of strictly unilateral continuous headache with accompanying ipsilateral autonomic symptoms. As diagnostic testing was unremarkable, hemicrania continua was suspected. A dose of 150 mg of indomethacin/day reduced the headache by 80%. Although an increase to 225 mg/day led to a further reduction of headaches, a new onset of moderate to severe pulsating migrainous bilateral headache developed.DISCUSSION: As shown in older studies, indomethacin can induce de novo headaches in a presumably dose-related fashion although the exact mechanism in uncertain. A treatable secondary origin of the indomethacin-induced headaches in patients with hemicrania continua or paroxysmal hemicrania (such as reversible cerebral vasoconstriction syndrome or aseptic meningitis) should be considered and excluded by further diagnostic testing if headaches persist after discontinuation of indomethacin.

KW - Adult

KW - Anti-Inflammatory Agents, Non-Steroidal

KW - Dose-Response Relationship, Drug

KW - Female

KW - Headache

KW - Humans

KW - Indomethacin

KW - Paroxysmal Hemicrania

U2 - 10.1177/0333102413490345

DO - 10.1177/0333102413490345

M3 - Other (editorial matter etc.)

C2 - 23709499

VL - 33

SP - 1203

EP - 1205

JO - CEPHALALGIA

JF - CEPHALALGIA

SN - 0333-1024

IS - 14

ER -