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LETTER TO EDITOR
Year : 2014  |  Volume : 62  |  Issue : 5  |  Page : 556-557

Cerebral venous thrombosis masquerading as hemicrania continua


Department of Neurology, St. John's Medical College Hospital, Bengaluru, Karnataka, India

Date of Submission04-Jul-2014
Date of Decision17-Jul-2014
Date of Acceptance25-Sep-2014
Date of Web Publication12-Nov-2014

Correspondence Address:
Thomas Mathew
Department of Neurology, St. John's Medical College Hospital, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.144486

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How to cite this article:
Mathew T, Badachi S, Sarma G, Nadig R. Cerebral venous thrombosis masquerading as hemicrania continua. Neurol India 2014;62:556-7

How to cite this URL:
Mathew T, Badachi S, Sarma G, Nadig R. Cerebral venous thrombosis masquerading as hemicrania continua. Neurol India [serial online] 2014 [cited 2019 Jul 20];62:556-7. Available from: http://www.neurologyindia.com/text.asp?2014/62/5/556/144486


Sir,

Hemicrania continua (HC) is an idiopathic, chronic disorder characterized by a continuous, strictly unilateral headache associated with ipsilateral cranial autonomic symptoms. The symptoms of HC typically respond to indomethacin therapy. [1] This report presents a patient with cerebral venous thrombosis (CVT) who presented with indomethacin responsive hemicrania, probably the first such case.

A 42-year-old man presented with persistent daily strictly right hemicranial headachfiguree of 1month duration. There were no pain-free periods. Headache was of moderate to severe in intensity with superimposed paroxysms of short-lasting (duration of up to 30 s) shooting pain in the same area. During exacerbations he would have conjunctival injection and nasal congestion on right side. Physical and neurological examination was normal. He was initially diagnosed to have hemicrania continua and was started on indomethacin 25 mg three times a day with complete resolution of headache within 24 h. After 2 weeks of therapy he had recurrence of headache whenever he missed indomethacin. He was further evaluated with magnetic resonance imaging (MRI) of brain which showed thrombosis of the right transverse sinus [Figure 1]. MR-venography confirmed the absence of flow in the right transverse sinus. He was started on anticoagulation and antiedema measures and indomethacin was stopped. He had no further headaches after 3 days and is currently asymptomatic.
Figure 1: Right tranverse sinus thrombosis (black arrows)

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Initially considered a rare disorder, HC is being increasingly recognized [2] and is now classified under trigeminal autonomic cephalalgias according to ICHD 3 Beta 2013. [3] Our patient has satisfied all the criteria for the HC except for the duration of headache, for the diagnosis of primary HC the duration should be 3 months. Secondary headaches mimicking primary HC (including response to indomethacin) have been reported. They include internal carotid artery dissection, unruptured aneurysm, pineal cyst, pituitary tumor, ipsilateral mesenchymal tumor of the sphenoidal bone involving the clinoid process at the base of the skull, lung adenocarcinoma, and pontine stroke. Headache is by far the most frequent initial (80-90%) symptom of CVT, which has no specific characteristics. Most often it is diffuse, progressive, severe, and associated with other signs of intracranial hypertension. Cluster-like headache secondary to CVT has been reported. [4] Patients who present with a clinical picture mimicking HC should be evaluated with a high index of suspicion for a possible CVT, even when the headache is responsive to indomethacin as it is associated with significant mortality and morbidity if not diagnosed and treated early. A secondary cause for HC should be considered when the duration of headache is shorter than 3 months.

 
  References Top

1.
Pareja JA, Antonaci F, Vincent M. The hemicrania continua diagnosis. Cephalalgia 2001;21:940-6.  Back to cited text no. 1
    
2.
Peres MF, Silberstein SD, Nahmias S, Shechter AL, Youssef I, Rozen TD, et al. Hemicrania continua is not that rare. Neurology 2001;57:948-51.  Back to cited text no. 2
    
3.
Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3 rd edition (beta version). Cephalalgia 2013;33:629-808.  Back to cited text no. 3
    
4.
Park KI, Chu K, Park JM, Kim M. Cluster-like headache secondary to cerebral venous thrombosis. J Clin Neurol 2006;2:70-3.  Back to cited text no. 4
    


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