Hemicrania continua in African Americans

The first six cases of hemicrania continua and episodica in African Americans are reported, differences from previous accounts noted, and important diagnostic features described. Hemicrania continua is an indomethacin responsive chronic daily headache. Mild to moderate daily headache is strictly unilateral, constant but fluctuating. Superimposed severe headache attacks occur, last seconds to days, and are associated with ipsilateral orbital-nasal autonomic dysfunction. Severe headache attacks are usually pulsatile, occur one to four times daily, and last 40 minutes to three days. Daily unilateral background headache was typically of a pressure, sharp, dull or pulling quality. Ipsilateral orbital-nasal autonomic symptoms were noted in all. Serious concomitant medical illnesses, e.g. coronary artery disease, diabetes, and hypertension, were frequent in this population. This is the first report of hemicrania continua and episodica in African Americans and the second in persons of African descent in the world's literature. Late age of onset, frequent serious medical illnesses, and family history of migraine differentiate this series from previous reports. The lack of reports in African Americans most likely reflects misdiagnosis rather than true prevalence. Thus, whenever any patient presents with chronic daily unilateral headache, ipsilateral autonomic symptoms should be assessed during severe headache attacks, and an indomethacin trial considered.