CPH AND HEMICRANIA CONTINUA - REQUIREMENTS OF HIGH INDOMETHACIN DOSAGES - AN OMINOUS SIGN

Two female patients, one with chronic paroxysmal hemicrania and one wi th hemicrania continua, had a continuously high requirement of indomet hacin, ie, greater than or equal to 225 mg per day, for 4 and 7 years, respectively. In the hemicrania continua patient, a right (symptomati c side) C7 root affection due to disc herniation was demonstrated. Rem oval of the disc relieved the arm pain completely, and reduced the hea d pain and indomethacin requirement considerably initially. The other patient suffered from the unremitting form of chronic paroxysmal hemic rania with right-sided attacks from the age of 16. Indomethacin. 200 t o 250 mg per day generally kept the headache at bay, but during exacer bations, especially during menstrual periods, the dosage transitorily had to be increased to 250 to 350 mg per day. A CT scan with contrast at aged 18 (1987) was negative. In 1992, she started having new sympto ms, including numbness on the ipsilateral side of the face and arm and difficulty swallowing. An MR scan showed a meningioma originating in the roof of the cavernous sinus on the symptomatic side. The meningiom a was surgically removed. The postoperative indomethacin requirement w as reduced. but only transiently. Patients with chronic paroxysmal hem icrania (CPH) and hemicrania continua (HC) with a continuously high in domethacin requirement may have grave additional disorders and should consequently be followed closely.