{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T02:27:42Z","timestamp":1793672862562,"version":"4.5.1"},"reference-count":16,"publisher":"Springer Science and Business Media LLC","issue":"10","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"vor","delay-in-days":5,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Neurol Sci"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Indomethacin responsiveness is considered the defining diagnostic feature of hemicrania continua and paroxysmal hemicrania. However, the clinical presentation of indomethacin-responsive headaches is often heterogeneous, and practical guidance regarding which patients should undergo an indomethacin trial, the optimal duration of treatment, and the interpretation of partial responses remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Cases<\/jats:title>\n                    <jats:p>\n                      Eighteen patients underwent an indomethacin trial in our pain centre over the last year, of whom eleven (61%) achieved a positive response. Positive responders included patients ultimately diagnosed with probable or definite hemicrania continua (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20096); and probable or definite paroxysmal hemicrania (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20095), including secondary forms. Clinical presentations frequently departed from ICHD-3 criteria. Trigeminal autonomic symptoms were absent in several responders, while migrainous features were common. Attack duration in patients with paroxysmal hemicrania frequently exceeded the 30-min upper limit defined by ICHD-3, and some patients presented with pain characteristics suggestive of neuropathic disorders. The median time to a clinically meaningful response was 13\u00a0days for hemicrania continua (range 3\u201335\u00a0days) and 11\u00a0days for paroxysmal hemicrania (range 4\u201323\u00a0days). Most patients responded to 150\u00a0mg\/day, although escalation to 225\u00a0mg\/day or prolonged treatment exceeding four weeks was occasionally required. Seven patients had negative trials, leading to alternative diagnoses including migraine, cluster headache, SUNA, post-traumatic headache, and idiopathic mandibular neuropathy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This case series illustrates the broad clinical spectrum of indomethacin-responsive headaches and highlights the limitations of relying exclusively on ICHD-3 criteria when selecting patients for an indomethacin trial. Clinical suspicion should remain broad, particularly in patients with strictly unilateral headaches, atypical trigeminal autonomic cephalalgias, or refractory unilateral primary headaches.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10072-026-09456-9","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T02:21:48Z","timestamp":1791253308000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Indomethacin testing in suspected paroxysmal hemicrania and hemicrania continua: Clinical phenotypes and response patterns in a tertiary headache centre"],"prefix":"10.1007","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-7600-1113","authenticated-orcid":false,"given":"Antoine","family":"Bender","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirela","family":"Muresan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauriane","family":"Joganah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Salvat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,6]]},"reference":[{"key":"9456_CR1","doi-asserted-by":"publisher","unstructured":"(2018) Headache classification committee of the international headache society (IHS) The international classification of headache disorders, 3rd edition. 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