n.

片側頭痛、片側性頭痛

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/08/28 11:39:11」(JST)

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Hemicrania continua (HC) is a persistent unilateral headache that responds to indomethacin. It is usually unremitting, but rare cases of remission have been documented.^[1] Hemicrania continua is considered a primary headache disorder, meaning that it is not caused by another condition.

Classification

The International Headache Society's International Classification of Headache Disorders classifies hemicrania continua as a primary headache disorder.^[2]

Diagnostic criteria

The following diagnostic criteria are given for hemicrania continua:^[2]

Headache for more than 3 months fulfilling other 3 criteria:
All of the following characteristics:
- Unilateral pain without side-shift
- Daily and continuous, without pain-free periods
- Moderate intensity, but with exacerbations of severe pain
At least one of the following autonomic features occurs during exacerbations and ipsilateral to the side of pain:
- Conjunctival injection and/or lacrimation
- Nasal congestion and/or rhinorrhea
- Ptosis and/or miosis
Complete response to therapeutic doses of indomethacin, although cases of hemicrania continua that do not resolve with indomethacin treatment have been documented.^[3]

A variant on hemicrania continua has also been described, in which the attacks may shift sides, although meeting the above criteria in all other respects.^[4]^[5]^[6]^[7]

Main features differentiating CPH from cluster headaches (migrainous neuralgia, above) are the higher frequency and shorter duration of attacks, higher incidence in women, and the response to treatment with indomethacin. CPH is not associated with cranial nerve palsies.

Epidemiology

Hemicrania was mentioned in 1881 in The Therapeutic Gazette Vol. 2, by G.S.Davis,^[8] and the incident has been cited in King's American Dispensatory (1898 and later editions)^[9] in the description of the strong analgesic Jamaican Dogwood, a relatively low dose of which reportedly produced convulsions and prolonged respiratory depression over six hours in an elderly woman with this condition.

In newer times, Hemicrania continua was described in 1981;^[10] at that time around 130 cases were described in the literature.^[10] However, rising awareness of the condition has led to increasingly frequent diagnosis in headache clinics, and it seems that it is not as rare as these figures would imply. The condition occurs more often in women than men and tends to present first in adulthood, although it has also been reported in children as young as 5 years old.^[11]

Cause and diagnosis

The cause of hemicrania continua is unknown. There is no definitive diagnostic test for hemicrania continua. Diagnostic tests such as imaging studies may be ordered to rule out other causes for the headache. When the symptoms of hemicrania continua are present, it's considered "diagnostic" if they respond completely to indomethacin. The efficacy of indomethacin may not be long term for all patients, as can eventually become ineffective.

The factor that allows hemicrania continua and its exacerbations to be differentiated from migraine and cluster headache is that hemicrania continua is completely responsive to indomethacin. Triptans and other abortive medications do not affect hemicrania continua.

Symptoms

In addition to persistent daily headache of HC, which is usually mild to moderate (and frequently severe), HC can present other symptoms.^[12] These additional symptoms of HC can be divided into three main categories:

Autonomic symptoms:
- conjunctival injection
- tearing
- rhinorrhea
- nasal stuffiness
- eyelid edema
- forehead sweating
Stabbing headaches:
- Short, "jabbing" headaches superimposed over the persistent daily headache.
- Usually lasting less than one minute.
Migrainous features:
- throbbing pain
- nausea and/or vomiting
- phonophobia
- photophobia

Treatment

Hemicrania continua generally responds only to indomethacin 25–300 mg daily, which must be continued long term. Unfortunately, gastrointestinal side effects are a common problem with indomethacin, which may require additional acid-suppression therapy to control.^[13]

In patients who are unable to tolerate indomethacin, the use of celecoxib 400–800 mg per day (Celebrex) and rofecoxib 50 mg per day (Vioxx - no longer available) have both been shown to be effective and are likely to be associated with fewer GI side effects.^[14] There have also been reports of two patients who were successfully managed with topiramate 100–200 mg per day (Topamax) although side effects with this treatment can also prove problematic.^[7]^[15]

Greater Occipital Nerve [GON] block comprising 40 mg Depomedrone and 10mls of 1% Lignocaine injected into the affected nerve is effective, up to a period of approximately three months. Changing the 'cocktail' to include [for example] 10mls of .5% Marcaine and changing to 2% Lignocaine, whilst in theory should increase the longevity, renders the injection completely ineffective. See 4.2 Posology and method of administration [flocculation] ^[16] ^[17]

Occipital nerve stimulation may be highly effective when other treatments fail to relieve the intractable pain. ^[18]

References

^ Mark Thompson, "Hemicrania Continua"
^ ^a ^b "The International Classification of Headache Disorders 2nd Edition (ICHD-2)" (PDF). the Headache Classification Subcommittee of the International Headache Society. Retrieved 2012-09-22.
^ Prakash, S; Shah, N. D.; Bhanvadia, R. J. (2009). "Hemicrania continua unresponsive or partially responsive to indomethacin: Does it exist? A diagnostic and therapeutic dilemma". The Journal of Headache and Pain 10 (1): 59–63. doi:10.1007/s10194-008-0088-9. PMC 3451756. PMID 19096758.
^ Newman LC, Lipton RB, Russell M, Solomon S (1992). "Hemicrania continua: attacks may alternate sides". Headache 32 (5): 237–8. doi:10.1111/j.1526-4610.1992.hed3205237.x. PMID 1628961.
^ Marano E, Giampiero V, Gennaro DR, di Stasio E, Bonusa S, Sorge F (1994). ""Hemicrania continua": a possible case with alternating sides". Cephalalgia 14 (4): 307–8. doi:10.1046/j.1468-2982.1994.1404305-4.x. PMID 7954766.
^ Newman LC, Spears RC, Lay CL (2004). "Hemicrania continua: a third case in which attacks alternate sides". Headache 44 (8): 821–3. doi:10.1111/j.1526-4610.2004.04153.x. PMID 15330832.
^ ^a ^b Matharu MS, Bradbury P, Swash M (2006). "Hemicrania continua: side alternation and response to topiramate". Cephalalgia 26 (3): 341–4. doi:10.1111/j.1468-2982.2005.01034.x. PMID 16472344.
^ Davis, G.S. (1881). The Therapeutic Gazette, Volume 2. p. 54.
^ King; Felter; Lloyd, John; Harvey Wickes; John Uri (1898). King's American Dispensatory. Cincinnati: Ohio Valley Co. p. 1511.
^ ^a ^b Medina JL, Diamond S (1981). "Cluster headache variant. Spectrum of a new headache syndrome". Arch. Neurol. 38 (11): 705–9. doi:10.1001/archneur.1981.00510110065010. PMID 7305699.
^ Peres MF, Silberstein SD, Nahmias S et al. (2001). "Hemicrania continua is not that rare". Neurology 57 (6): 948–51. doi:10.1212/wnl.57.6.948. PMID 11577748.
^ Goadsby P, Silberstein S, Dodick D (205). Chronic Daily Headache for clinicians. B C Decker Inc. p. 220. ISBN 1-55009-265-0.
^ Pareja JA, Caminero AB, Franco E, Casado JL, Pascual J, Sánchez del Río M (2001). "Dose, efficacy and tolerability of long-term indomethacin treatment of chronic paroxysmal hemicrania and hemicrania continua". Cephalalgia : an international journal of headache 21 (9): 906–10. doi:10.1046/j.1468-2982.2001.00287.x. PMID 11903285.
^ Peres MF, Silberstein SD (2002). "Hemicrania continua responds to cyclooxygenase-2 inhibitors". Headache 42 (6): 530–1. doi:10.1046/j.1526-4610.2002.02131.x. PMID 12167145.
^ Brighina F, Palermo A, Cosentino G, Fierro B (2007). "Prophylaxis of hemicrania continua: two new cases effectively treated with topiramate". Headache 47 (3): 441–3. doi:10.1111/j.1526-4610.2007.00733.x. PMID 17371364.
^ http://www.drugs.com/uk/pdf/leaflet/261720.pdf
^ http://onlinelibrary.wiley.com/doi/10.1111/head.12053/abstract
^ http://www.neurologyreviews.com/the-publication/past-issue-sngle-view/occipital-nerve-stimulation-for-headache/7ef763329e4d7dd532baab0ce8087da9.html

UpToDate Contents

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1. 発作性片側頭痛：臨床的特徴および診断 paroxysmal hemicrania clinical features and diagnosis
2. 持続性片側頭痛 hemicrania continua
3. 発作性片側頭痛：治療および予後 paroxysmal hemicrania treatment and prognosis
4. 短時間持続性片側神経痛様頭痛発作：臨床的特徴および診断 short lasting unilateral neuralgiform headache attacks clinical features and diagnosis
5. 群発頭痛：疫学、臨床的特徴、および診断 cluster headache epidemiology clinical features and diagnosis

English Journal

A clinical manifestation-based prediction of haemodynamic patterns of orthostatic intolerance in children: a multi-centre study.

Chen L1, Li X2, Todd O3, Wang C4, Jin H1, Du J1.
Cardiology in the young.Cardiol Young.2014 Aug;24(4):649-53. doi: 10.1017/S1047951113000929. Epub 2013 Jul 18.
Objective: At present, the haemodynamic diagnosis of orthostatic intolerance is based mainly on the head-up tilt table test, which is sometimes risky for patients. Thus, it is important to find objective and safe methods to differentiate haemodynamic patterns of orthostatic intolerance cases. Method
PMID 23866994

Clinical relevance of fascial tissue and dysfunctions.

Klingler W1, Velders M, Hoppe K, Pedro M, Schleip R.
Current pain and headache reports.Curr Pain Headache Rep.2014 Aug;18(8):439. doi: 10.1007/s11916-014-0439-y.
Fascia is composed of collagenous connective tissue surrounding and interpenetrating skeletal muscle, joints, organs, nerves, and vascular beds. Fascial tissue forms a whole-body, continuous three-dimensional viscoelastic matrix of structural support. The classical concept of its mere passive role i
PMID 24962403

The risk of suicide mortality in chronic pain patients.

Hassett AL1, Aquino JK, Ilgen MA.
Current pain and headache reports.Curr Pain Headache Rep.2014 Aug;18(8):436. doi: 10.1007/s11916-014-0436-1.
Chronic pain has long been considered an important risk factor for suicidal behavior. Less well understood are the factors associated with the increased risk for suicide death within chronic pain populations. The purpose of this review is to examine recent research with regard to rates of and risk f
PMID 24952608

Japanese Journal

持続性片側頭痛の長期治療～pregabalinやtopiramate併用によるindomethacin減量の試み～

神経治療学 33(1), 53-56, 2016
NAID 130005152232

片頭痛とてんかん

臨床神経学 54(12), 1003-1005, 2014
NAID 130004921205

低用量インドメタシンとプレガバリンの併用が有用であった持続性片側頭痛の1例

臨床神経学 54(10), 824-826, 2014
NAID 130004700499

Related Pictures

★リンクテーブル★

リンク元	「片頭痛」「拍動性頭痛」「起立性頭痛」「unilateral headache」「cranial pain」
拡張検索	「chronic paroxysmal hemicrania」

「片頭痛」

Hemicrania continua
Classification and external resources
Specialty	neurology
ICD-10	G44.80
ICD-9-CM	339.41

　　[★]

日: へんずつう
英: migraine
ラ: hemicrania
同: 片頭痛型血管性頭痛 vascular headache of migraine type
関: 頭痛、機能性頭痛。片頭痛治療薬

[show details]

片頭痛 : 約 1,400,000 件
偏頭痛 : 約 4,050,000 件

概念

機能性頭痛の一種であり、拍動性頭痛が特徴的で、前兆(閃輝暗点)を伴うことがある。頭痛の持続時間は72時間以上持続することはない。片側性であることが多く、日常生活に支障をきたす中等度～重度の頭痛である。
家族歴がありうる　→　緊張型頭痛に家族歴があることは少ない

日常生活が妨げられ、悪心、嘔吐、光過敏を伴う頭痛 (感度81%, 特異度75%)(めざせ外来診療の達人第3版 p.6)

疫学

頻度：8.4　　←　　何に対しての頻度なのか不明。
頭痛に対して片頭痛が占める割合は16% (Goadsby PJ:Diagnosis and management of migraine, BMJ 312:1279, 1996)
男女比=1:3.6
家族歴がある場合があり、遺伝性が示唆される。片親が片頭痛の場合、50%。

誘因

月経、肩こり、ストレス、睡眠不足、過眠、光、騒音など

HBN.219

身体精神的因子(疲労・ストレス、およびその解放後、激しい運動、性交、睡眠不足、睡眠過多、空腹など)　　→　　ストレスが最も多い
食事因子(チラミンや亜硫酸塩などを含むチョコレート、コーヒー、紅茶、熟成チーズ、乳製品、香辛料、グルタミン酸ナトリウム、ナッツ、ホットドック、ソーセージ、柑橘類、海藻、飲酒など)
薬剤(経口避妊薬、エストロゲン療法およびその離脱、硝酸薬や降圧薬などの血管拡張薬など)
環境因子(入浴・冷暖房による温度差、騒音、炎天、飛行機の離着陸時の気温差、騒音、臭気など)、アレルギー性因子(アレルギー性鼻炎、副鼻腔炎、気管支喘息)