[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-417166-105":59,"doc-detail-417166-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","rare-but-critical-indomethacin-responsive-headache-with-long-lasting-autonomic-symptoms","Rare but Critical: Indomethacin-Responsive Headache with Long-Lasting Autonomic Symptoms","","Rare but Critical presents a clinical description of hemicrania with long-lasting autonomic symptoms (LASH), a very rare headache disorder considered part of the trigeminal autonomic cephalalgia spectrum. The paper emphasizes typical indomethacin responsiveness and characterizes unilateral moderate-to-severe headache with cranial autonomic symptoms that begin before pain, last 1–3 days, and may persist after headache resolution. A case report details imaging findings, medication discontinuation relapse, diagnostic considerations, differential diagnosis, and comparison against related indomethacin-responsive headache types with autonomic features.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/rare-but-critical-indomethacin-responsive-headache-with-long-lasting-autonomic-symptoms/417166/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/rare-but-critical-indomethacin-responsive-headache-with-long-lasting-autonomic-symptoms/417166.png","ImageObject",300,407,{"name":92,"@type":93},"nayy☆","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":52},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What defines hemicrania with long-lasting autonomic symptoms (LASH)?","Question",{"text":112,"@type":113},"LASH features unilateral moderate-to-severe headache accompanied by prolonged cranial autonomic symptoms. The autonomic symptoms begin before headache onset, persist for 1–3 days, and continue for some time after headache resolution.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How does indomethacin affect the symptoms in this report?",{"text":117,"@type":113},"After starting indomethacin 25 mg twice daily, the patient remained free of headache and autonomic symptoms for 3 months. Relapse occurred with typical episodes after discontinuation, and symptoms again resolved when indomethacin was restarted.",{"name":119,"@type":110,"acceptedAnswer":120},"Why was Horner’s syndrome considered unlikely in the differential diagnosis?",{"text":121,"@type":113},"The absence of ipsilateral miosis, anhidrosis, and enophthalmos made Horner’s syndrome unlikely. Additionally, imaging and clinical findings argued against other alternative causes.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},417166,1791092573,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":52,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":14,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":24,"preview_page_count":4},962090893153,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","Scientific Letter  50  \nContent of this journal is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.  \nBalkan Med J 2026;43:50-1  \nRare but Critical: Indomethacin-Responsive Headache with Long  \nLasting Autonomic Symptoms  \n Tural Talibov1 ,  Meltem İnci2 ,  Esme Ekizoğlu2 ,  Betül Baykan2  \n1Department of Neurology, İstanbul Health and Technology University Faculty of Medicine, İstanbul, Türkiye 2Department of Neurology, İstanbul University Faculty of Medicine, İstanbul, Türkiye  \nHemicrania with long-lasting autonomic symptoms (LASH), first described in by Rozen1, is an extremely rare headache disorder thought to be part of the trigeminal autonomic cephalalgia (TAC) spectrum. However, it is not included in the current International Classification of Headache Disorders, 3rd Edition (ICHD-3) .2 Notably, patients with LASH typically respond well to indomethacin. The condition is characterized by a moderate-to-severe unilateral headache accompanied by prolonged cranial autonomic symptoms, which begin before headache onset, persist for 1-3 days, and continue for some time after headache resolution. Headache attacks last longer than those of typical TACs-often for several hours-and patients remain pain-free between attacks.3 A 32-year-old right-handed man presented with a 2-year history of headache attacks of moderate intensity. These episodes were accompanied by right eyelid edema and ptosis, as well as pruritus in the right eye. The headache lasted only 30-40 minutes, but ipsilateral autonomic symptoms persisted for 1-2 days. The patient did not report associated nausea, vomiting, photophobia, phonophobia, irritability, or restlessness. He denied that chewing, head or neck movements, or facial palpation provoked either headache or autonomic symptoms. Over the 2-year period, he experienced an average of one attack per month, with no other headaches between episodes. His medical history and neurological examination were unremarkable between attacks. Brain magnetic resonance imaging (MRI), MR angiography, and MR venography were all normal. Ophthalmological examination revealed no additional abnormalities.  \nThe patient remained free of headache and autonomic symptoms for 3 months after starting indomethacin at a dose of 25 mg twice daily. However, he experienced three episodes of typical headache and autonomic symptoms within 1 month of discontinuing the medication. At his second admission, he presented during a typical  \nheadache attack with right eyelid edema and ptosis. Neurological examination during the attack revealed right-sided ptosis without anisocoria or anhidrosis (Figure 1a) . Complete resolution of the ptosisand eyelid edema was observed 2 days after the headache (Figure 1b) . Indomethacin was then restarted, and the patient remained free of headache and autonomic symptoms for the following 2 months.  \nIn the differential diagnosis of a patient presenting with headache, ptosis, and periorbital edema, Horner’s syndrome and idiopathic orbital inflammation were considered. The absence of ipsilateral miosis, anhidrosis, and enophthalmos made Horner’s syndrome unlikely. Furthermore, contrast-enhanced cranial MRI revealed no enlargement or contrast enhancement of the extraocular muscles or periorbital soft tissues, thereby excluding idiopathic orbital inflammation.  \nPreviously reported cases of LASH in the literature have shown a female predominance, with a mean age of onset of 33 years (range, 19-46 years) . The average time to diagnosis has been reported to be delayed by up to 3 years.3 Among headaches that respond to indomethacin, only a subset present with cranial autonomic symptoms such aslacrimation, conjunctival injection, nasal congestion, rhinorrhea, ptosis, and miosis. The principal indomethacin-responsive headache disorders with autonomic features are hemicrania continua, paroxysmal hemicrania, and LASH.1,2 These headache types can be differentiated by attack fre","cbCaikUPCOEqYDQZ","https://ap.wps.com/l/cbCaikUPCOEqYDQZ","pdf",422339,"English","# Rare but Critical: Indomethacin-Responsive Headache with Long-Lasting Autonomic Symptoms\n## Clinical presentation and indomethacin response\n## Differential diagnosis and diagnostic rationale\n## Distinguishing features vs related indomethacin-responsive headache types","[{\"question\":\"What defines hemicrania with long-lasting autonomic symptoms (LASH)?\",\"answer\":\"LASH features unilateral moderate-to-severe headache accompanied by prolonged cranial autonomic symptoms. The autonomic symptoms begin before headache onset, persist for 1–3 days, and continue for some time after headache resolution.\"},{\"question\":\"How does indomethacin affect the symptoms in this report?\",\"answer\":\"After starting indomethacin 25 mg twice daily, the patient remained free of headache and autonomic symptoms for 3 months. Relapse occurred with typical episodes after discontinuation, and symptoms again resolved when indomethacin was restarted.\"},{\"question\":\"Why was Horner’s syndrome considered unlikely in the differential diagnosis?\",\"answer\":\"The absence of ipsilateral miosis, anhidrosis, and enophthalmos made Horner’s syndrome unlikely. Additionally, imaging and clinical findings argued against other alternative causes.\"}]","Rare but Critical: Indomethacin-Responsive Headache with Long-Lasting Autonomic Symptoms | PDF",1790608303]