Clinical studies of indometacin sensitive headache and unilateral migraine

Paroxysmal hemicrania and hemicrania continuaare primary headache syndromes characterized by exquisite response to indometacin. Migrainousfeatures such as phonophobiaand photophobiaoccur in hemicrania continuaand the differential diagnosis with unilateralchronic migrainecan be challenging. This thesis explores the phenotypical aspects of paroxysmal hemicrania, hemicrania continuaand unilateralchronic 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 continuafrom unilateralchronic 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 autonomicfeatures occurs with the attacks. The study of thirty-nine patients with hemicrania continuashows 92% of patients have side-locked pain. Ninety-five per cent of patients have at least one autonomicfeature and a wider range of autonomicfeatures occurs with severe pain. The study comparing twenty-seven patients with hemicrania continuaand twenty-seven patients with indometacinnegative unilateralchronic migraineshows that both syndromes share several clinical characteristics. However, cranial autonomicfeatures and phonophobiaand photophobiatend 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 continuashould be revised. The results suggest to remove specification of attack site, and to include the full range of autonomicfeatures in paroxysmal hemicrania; to allow side-swift of the pain, to include a more extensive range of autonomicfeatures, and to consider the occurrence of autonomicfeatures as an important but not an essential criterion in hemicrania continua. In addition, unilateralcranial autonomicfeatures and phonophobiaand photophobiamay be helpful during the differential diagnosis between hemicrania continuaand chronic migraine.