Indomethacin Responsive Headache Syndromes

SYNOPSIS Three headache syndromes which respond clinically to Indomethacin therapy are described. These include l) Indomethacin responsive cluster headache (chronic paroxysmal hemicrania). Four patients who were unresponsive to Sansert, Prednisone and Lithium responded significantly to Indomethacin and not to placebo. Distinguishing features were (a) numerous attacks a day, (b) headaches are sudden in onset, severe and last on an average of 15–20 minutes, (c) long history of headaches without remission. 2) Sharp, short lived head pain syndrome (SSHP). Synonyms are ice pick like headache, “jabs and jolts”, and “needle in the eye syndrome”. Five cases are described. These head pains are variable in location, sudden, sharp and last only for seconds to a few minutes. They are common in a migraine population, but may occur as a primary manifestation in some, especially those above the age of 60. Etiology is uncertain. Response to Indomethacin is dramatic. 3) Exertional headache. Two cases of benign cough headache resistant to many other antimigraine agents responded to Indomethacin in a double blind cross over evaluation. Headache syndromes which respond to Indomethacin, as a general rule, are of sudden onset, with severe short lived head pains. Specific action of Indomethacin in this syndrome is not clear. The possible role of prostaglandins and prostacyclins in the production of head pains and the effect of Indomethacin on the prostaglandin system is discussed.