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Ask the Expert: Hemicrania Continua

Do you have anyone I can contact regarding Hemicrania Continua symptoms and treatment, please? Also, I’d love to connect with other sufferers, as I have nobody to talk to who understands what it is like to live with this disease.

Answer:

Hemicrania continua is a form of chronic daily headache of more than 3 months that is one-sided and continuous in duration.  It is more common in women than men in approximately a 2:1 female to male ratio and tends to start around the third decade of life, although can occur in almost all age groups.  Although the pain is continuous, the severity can fluctuate and there can be attacks of more severe pain at times.  The pain most commonly occurs in the frontal region and around the eye and temple regions.  Sometimes the pain can occur at the back of the head at the occiput.  In addition to headache pain, patients can experience one-sided tearing of the eye, redness of the conjunctiva, nasal congestion, facial flushing, eyelid swelling, drooping of the eyelid, etc.  The headache of hemicrania is always one-sided (“side-locked”) and does not move to the other side.

Patients with suspected hemicrania continua should obtain MRI imaging of the brain to rule out structural brain lesions.  Treatment consists of a trial of indomethacin, which is an NSAID that can be used to treat gout, and the response to indomethacin in doses from 100 to 200 mg per day divided into three doses throughout the day.  The clinical response to indomethacin is fairly quick (sometimes in less than 24 hours) and the complete responsiveness of the headache and other symptoms to indomethacin is by definition required to diagnose hemicrania continua.  If the treatment does not resolve the headache within 5 to 9 days, it is considered a failed trial.  Alternative medications for patients that do not respond or cannot tolerate indomethacin include cyclooxygenase-2 inhibitors (celecoxib/Celebrex), anti-epileptic agents (topiramate/Topamax), calcium channel blockers (verapamil), melatonin and nerve blocks. These treatments, however, are likely less effective overall than indomethacin.

George R. Nissan, DO
North Texas Institute of Neurology and Headache
Plano, Texas

Answer regarding support groups:

There are many migraine and headache support groups on Facebook. We would suggest reaching out in those private groups and asking if anyone else is living with hemicrania continua. These are groups are very supportive and they are a vital resource for many in the community.

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