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Reader's Mail: Unresolved Headache Calls for Prompt Follow-up

Q. I saw a consultant 11 days ago who prescribed the drug indomethacin for my constant right-sided headache that I have had for the last nine weeks. I had an MRI scan showing nothing sinister. However, this drug is not working, and I don’t know if I am expecting it to work too soon. I am in a lot of pain tonight and am seeing the consultant next Sunday. Should the drug be having an effect by now? As I am pushing my appointment forward, am I doing the right thing? I can’t believe I am still in pain. The dosage is 50mg three times daily. Hoping you can advise me.

A. From the headache description and dose of medication, I might deduce that the working diagnosis may be an uncommon headache condition known as hemicrania continua. This medication is the drug of choice for this condition, and although doses of 150 mg per day are typically effective, occasionally higher doses may be required. When a response is achieved with this drug, it usually appears within the first one to two weeks, almost miraculously “curing” the headaches in many cases. If a response is not seen at 150 mg by this time, either more medication will be required or the diagnosis must be reconsidered. Either way, moving up the appointment is an appropriate course of action.

Robert Kaniecki, MD
Director of The Headache Center, Chief of the Headache Division and Assistant Professor of Neurology
University of Pittsburgh

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