Abstract Details

Title Hemicrania continua successfully treated long-term with botulinum toxin type A: a case report

Topic Headache

Presentation(s) P6 - Poster Session 6 (8:00 AM-9:00 AM)

Poster/Presentation
Number 12-010

Objective N/A

Background Hemicrania continua requires specific diagnostic and therapeutic treatment with indomethacin. However, this medication’s unfavorable side effect profile often precludes its long-term use. There are few effective alternative treatments in existence.

Design/Methods

N/A

Results A 64 yo male with a history of HTN, GERD, iron deficiency anemia and episodic migraine with aura once a month presented with new-onset continuous, intense, sharp pain located in the left temporal region. In contrast to his usual migraine which stopped occurring right before this pain started, there was no associated nausea, dizziness, visual aura or positive response to triptans. He also denied jaw pain or claudication. ESR was 11 and a contrast-enhanced MRI brain was unremarkable. Treatment with amitriptyline and topiramate was unsuccessful. Autonomic symptoms, which were initially absent, later appeared as ipsilateral periorbital redness, edema and nasal congestion which suggested a trigeminal autonomic cephalalgia. A trial of indomethacin induced near immediate resolution of his symptoms at a dose 50 mg TID, but had to be quickly discontinued due to hematochezia and abdominal discomfort. However, all of his symptoms went into complete remission again within 2 weeks of treatment with botulinum toxin type A (PREEMPT trial protocol with 155 units) repeated every 12 weeks. He continues to be well controlled on this treatment three years on, with occasional breakthrough pain at week 10-11 from the last botulinum toxin injection.

Conclusions

Chemodenervation may be an effective long-term treatment for patients with hemicrania continua that have intolerance or contraindications to indomethacin.

Authors/Disclosures
Fatima Traore, MD (Bon Secours Neurology) PRESENTER	Dr. Traore has nothing to disclose.
Lucas Restrepo, MD, PhD (UCLA Medical Center)	Dr. Restrepo has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Eisai. Dr. Restrepo has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Lilly USA. Dr. Restrepo has received personal compensation in the range of $1,000,000+ for serving as an officer or member of the Board of Directors for Kelvi/Hypothermia Devices, Inc.. Dr. Restrepo has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for SAGE Journals, The Neurohospitalist. Dr. Restrepo has stock in Hypothermia Devices, Inc. (dba Kelvi). Dr. Restrepo has stock in Eli Lilly. Dr. Restrepo has received intellectual property interests from a discovery or technology relating to health care.

��ɫ��

��ɫ��