Clinical studies of indometacin sensitive headache and unilateral migraine

Paroxysmal hemicrania and hemicrania continua are primary headache syndromes characterized by exquisite response to indometacin. Migrainous features such as phonophobia and photophobia occur in hemicrania continua and the differential diagnosis with unilateral chronic migraine can be challenging. This thesis explores the phenotypical aspects of paroxysmal hemicrania, hemicrania continua and unilateral chronic migraine, revisits the current criteria for the identification of paroxysmal hemicrania and hemicrania continua, and identifies clinical markers that can be used to differentiate hemicrania continua from unilateral chronic migraine. The study of thirty-one patients with paroxysmal hemicrania shows the pain is in a wider area of the head and face and a full range of cranial autonomic features occurs with the attacks. The study of thirty-nine patients with hemicrania continua shows 92% of patients have side-locked pain. Ninety-five per cent of patients have at least one autonomic feature and a wider range of autonomic features occurs with severe pain. The study comparing twenty-seven patients with hemicrania continua and twenty-seven patients with indometacin negative unilateral chronic migraine shows that both syndromes share several clinical characteristics. However, cranial autonomic features and phonophobia and photophobia tend to be lateralized to the same side of the pain in hemicrania continua. The thesis concludes that the International Headache Society criteria for paroxysmal hemicrania and hemicrania continua should be revised. The results suggest to remove specification of attack site, and to include the full range of autonomic features in paroxysmal hemicrania; to allow side-swift of the pain, to include a more extensive range of autonomic features, and to consider the occurrence of autonomic features as an important but not an essential criterion in hemicrania continua. In addition, unilateral cranial autonomic features and phonophobia and photophobia may be helpful during the differential diagnosis between hemicrania continua and chronic migraine