Therapeutical approaches to paroxysmal hemicrania, hemicrania continua and short lasting unilateral neuralgiform headache attacks: a critical appraisal

• Published in: Journal of headache and pain 2017-12, Vol.18 (1), p.71-18, Article 71
• Main Authors: Baraldi, Carlo, Pellesi, Lanfranco, Guerzoni, Simona, Cainazzo, Maria Michela, Pini, Luigi Alberto
• Format: Article
• Language: English
• Subjects: Amines - administration & dosage; Analgesics - administration & dosage; Anticonvulsants - administration & dosage; Celecoxib; Clinical outcomes; Cyclohexanecarboxylic Acids - administration & dosage; Drug therapy; Female; Fructose - administration & dosage; Fructose - analogs & derivatives; Gabapentin; gamma-Aminobutyric Acid - administration & dosage; Headache; Headaches; Humans; Indomethacin; Indomethacin - administration & dosage; Internal Medicine; Intravenous administration; Lamotrigine; Lidocaine; Lidocaine - administration & dosage; Male; Medicine; Medicine & Public Health; Neuralgia - diagnosis; Neuralgia - drug therapy; Neuralgia - epidemiology; Neurology; Pain Medicine; Paroxysmal Hemicrania - diagnosis; Paroxysmal Hemicrania - drug therapy; Paroxysmal Hemicrania - epidemiology; pH effects; Piroxicam; Reproducibility of Results; Research Article; Steroid hormones; SUNCT Syndrome - diagnosis; SUNCT Syndrome - drug therapy; SUNCT Syndrome - epidemiology; Surveys and Questionnaires; Topiramate; Triazines - administration & dosage; Trigeminal Autonomic Cephalalgias - diagnosis; Trigeminal Autonomic Cephalalgias - drug therapy; Trigeminal Autonomic Cephalalgias - epidemiology
• ISSN: 1129-2369; 1129-2377
• DOI: 10.1186/s10194-017-0777-3

Background Hemicrania continua (HC), paroxysmal hemicrania (PH) and short lasting neuralgiform headache attacks (SUNCT and SUNA) are rare syndromes with a difficult therapeutic approach. The aim of this review is to summarize all articles dealing with treatments for HC, PH, SUNCT and SUNA, comparing them in terms of effectiveness and safety. Methods A survey was performed using the pubmed database for documents published from the 1st January 1989 onwards. All types of articles were considered, those ones dealing with symptomatic cases and non-English written ones were excluded. Results Indomethacin is the best treatment both for HC and PH. For the acute treatment of HC, piroxicam and celecoxib have shown good results, whilst for the prolonged treatment celecoxib, topiramate and gabapentin are good options besides indomethacin. For PH the best drug besides indomethacin is piroxicam, both for acute and prolonged treatment. For SUNCT and SUNA the most effective treatments are intravenous or subcutaneous lidocaine for the acute treatment of active phases and lamotrigine for the their prevention. Other effective therapeutic options are intravenous steroids for acute treatment and topiramate for prolonged treatment. Non-pharmacological techniques have shown good results in SUNCT and SUNA but, since they have been tried on a small number of patients, the reliability of their efficacy is poor and their safety profile mostly unknown. Conclusions Besides a great number of treatments tried, HC, PH, SUNCT and SUNA management remains difficult, according with their unknown pathogenesis and their rarity, which strongly limits the studies upon these conditions. Further studies are needed to better define the treatment of choice for these conditions.