Abstract
Hemicrania continua (HC) is one of the trigeminal autonomic cephalalgias which clearly responds to indomethacin. However, the symptoms recur after the discontinuation of indomethacin which may require long–term indomethacin administration in many cases.Ongoing use of indomethacin can provide significant side effects such as dizziness and nausea, which will decrease the tolerability of indomethacin. These side effects sometimes include severe gastrointestinal and renal disorders. We followed clinical courses of eight HC patients, all of whom received administration of indomethacin or indomethacin farnesil. The diagnosis of HC was made according to the International Classification of Headache Disorders 3rd edition (beta version). The transition of symptoms, administrative dosages of indomethacin or indomethacin farnesil, and the use of concomitant medicines were examined retrospectively through the medical charts of Tominaga Hospital. In two patients, the administration of indomethacin was gradually decreased and then successfully discontinued. In six patients, the administrative dosages of indomethacin or indomethacin farnesil could not be decreased. Either pregabalin or topiramate, both of which are generally used for the prevention of neuropathic pain and migraine in Japan, was concomitantly administered to those six patients. After the addition of these substances, the administration of indomethacin was discontinued in one patient, and the doses of indomethacin or indomethacin farnesil were decreased in four patients.The administrative dosage of indomethacin or indomethacin farnesil is less in Japan than that in Europe and the United States. Treatment of HC requires long–term administration of indomethacin. It is suggested that the concomitant administration of pregabalin or topiramate may be able to reduce the administrative dosage of indomethacin, which warrants to achieve the goal of preventing tolerability decrease and serious adverse drug reactions.
