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Table of Contents    
Year : 2022  |  Volume : 70  |  Issue : 4  |  Page : 1670

Indomethacin Resistant Hemicrania Continua Responsive to Venlafaxine

1 Department of Neurology, Akdeniz University Medical Faculty, Antalya, Turkey
2 Department of Pharmacology, Akdeniz University Medical Faculty, Antalya, Turkey

Date of Submission03-Jan-2020
Date of Decision08-Feb-2020
Date of Acceptance18-May-2020
Date of Web Publication30-Aug-2022

Correspondence Address:
Babur Dora
Akdeniz University Medical Faculty, Department of Neurology, Dumlupınar Bulvarı, Konyaalt., Antalya
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0028-3886.355083

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How to cite this article:
Dora B, Demir-Dora D. Indomethacin Resistant Hemicrania Continua Responsive to Venlafaxine. Neurol India 2022;70:1670

How to cite this URL:
Dora B, Demir-Dora D. Indomethacin Resistant Hemicrania Continua Responsive to Venlafaxine. Neurol India [serial online] 2022 [cited 2022 Oct 2];70:1670. Available from: https://www.neurologyindia.com/text.asp?2022/70/4/1670/355083


Although the response to indomethacin is a required diagnostic criterion for hemicrania continua, cases unresponsive to indomethacin have increasingly been reported.[1],[2],[3] In indomethacin unresponsive cases, the alternative treatment is not clear and controlled studies don't exist due to the infrequent nature of the disorder. Among several different drugs tried in hemicrania continua, antidepressants such as amitriptyline and fluoxetine have been reported to be of no, or minimal benefit.[1],[2],[3],[4]

We report a 41-year-old woman with a 2-year history of a strictly left-sided continuous hemicranial headache of burning or aching quality of mild intensity (visual analog scale [VAS] score 2-3/10), which was present day-and-night but didn't interfere with daily activities or sleep. She reported no accompanying symptoms. She had severe (of VAS 7/10, sometimes reaching 10/10) exacerbations of the pain, located around the left eye and forehead, of burning, ripping, throbbing and boring quality, occuring 5-6 times monthly, and lasting from a few to 48 hours. The severe pain was always accompanied by reddening and lacrimation of the left eye and nasal congestion. She also reported to have migraine headaches for 15 years, 1-3/month with uni-bilateral pressing pain, accompanied by photo-sonophobia, osmophobia and exacerbation with physical activity. She clearly stated that the exacerbation phase of the “other” headache was much worse than her migraine bouts. Her neurological examination, laboratory tests and brain MRI and MR angiography were normal.

She was diagnosed with hemicrania continua and started on indomethacin 25 mg tid. After 1 week she reported minimal improvement of the headache and the dose was increased to 150 mg/day, and later to 225 mg/day with no additional improvement. She discontinued indomethacin due to lack of response and was started on topiramate 100 mg/day which she couldn't tolerate due to mental and psychiatric side effects. She was then started on venlafaxin 75 mg/day for her depression. After 3 months, she reported that the continuous daily headache improved and only recurred 2-3 days a week and she had no exacerbation periods during the last 2 months. The venlafaxine dose was increased to 150 mg/day. After 3 months, she was completely headache free, and after 6 months, she had no recurrence of the headache except for occasional mild attacks of migraine.

Venlafaxine is an antidepressant drug of the serotonin and norepinephrine reuptake inhibitors (SNRI) group, which is commonly used in many pain conditions such as migraine, fibromyalgia or neuropathic pain. Despite its common use in the treatment of pain, this is the first report of hemicrania continua responsive to venlafaxine.[1],[2],[3],[4]

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Conflicts of interest

There are no conflicts of interest.

  References Top

Rossi P, Faroni J, Tassorelli C, Nappi G. Diagnostic delay and suboptimal management in a referral population with hemicrania continua. Headache 2009;49:227-34.  Back to cited text no. 1
Baraldi C, Pellesi L, Guerzoni S, Cainazzo MM, Pini LA. Therapeutic approaches to paroxysmal hemicrania, hemicrania continua and short lasting unilateral neuralgiform headache attacks: A critical appraisal. J Headache Pain 2017;18:71-89.  Back to cited text no. 2
Zhu S, McGeeney B. When indomethacin fails: Additional treatments for “indomethacin responsive headaches”. Curr Pain Headache Rep 2015;19:7-13.  Back to cited text no. 3
Moura LM, Bezerra JM, Fleming NR. Treatment of hemicrania continua: Case series and literature review. Rev Bras Anestesiol 2012;62:173-87.  Back to cited text no. 4


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