Chronic paroxysmal hemicrania and hemicrania continua. Parenteral indomethacin: the 'indotest'

Headache
F AntonaciO Sjaastad

Abstract

The interval between indomethacin administration and clinical response may be clinically relevant in the assessment of chronic paroxysmal hemicrania and hemicrania continua and other unilateral headache disorders with which they can be confounded. Eight patients with chronic paroxysmal hemicrania (6 women and 2 men) and 12 patients with hemicrania continua (8 women and 4 men) were entered into the study. The patients were given 50 mg of indomethacin intramuscularly (i.m.) on day 1 and some of them 100 mg IM on day 2 in an open fashion. The usual attack pattern was reestablished prior to the second test. The mean interval between attacks before the two injections (51 +/- 18 minutes) in chronic paroxysmal hemicrania was significantly shorter than the mean after each of the two indomethacin injections (50 mg = 493 +/- 251 minutes; 100 mg = 668 +/- 211 minutes; P < 0.001; Mann-Whitney test). In every patient, there was a clear refractory period after indomethacin. Since the first "expected" attack after indomethacin administration did not occur, it can, with reasonable certainty, be assumed that the protective phase was initiated already prior to the time of the next "anticipated" attack. The mean attack duration was 22 minutes (la...Continue Reading

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