Hemicrania continua

What is hemicrania continua?

Hemicrania continua describes a continuous, fluctuating, pain present on one side of the head.

Symptoms

The pain is usually mild to moderate in intensity. For many people with this condition they have episodes of severe pain on top of the continuous general pain.

During these painful episodes (or exacerbations), other symptoms also occur:

• cranial autonomic symptoms such as eye-watering, eye redness, nasal blocking or running and eye lid drooping. These will occur on the same side of the pain.
• migraine symptoms such as light, sound or smell sensitivity, nausea and vomiting.

It’s not known what causes hemicrania continua. It’s not clear whether there is a genetic element or triggering factors, as in migraine.

Diagnosis

Hemicrania continua has a positive response when treated with the medication, indomethacin. This is an NSAID (non steroidal anti inflammatory drug). It is recommended that a trial of indomethacin is carried out while a strict headache diary is kept.

After a period of time (days to weeks) with an increasing dose of indomethacin, any change in the headache and symptom severity is assessed. This is compared to the headache pattern before the indomethacin was started.

If you have hemicrania continua you can also experience other types of headache such as migraine. It is always useful to keep a detailed headache diary in order to identify different headache types as it leads to different treatments.

Treatment options for hemicrania continua

The most effective treatment for hemicrania continua is indomethacin which is also used for the diagnosis. However, not everyone can tolerate indomethacin on a daily basis and other treatments can be useful. There is currently no cure for hemicrania continua and preventive treatments are used to control the symptoms.

Hemicrania continua diary

Keeping a headache diary is crucial for diagnosis and treatment monitoring. Useful information that the headache diary may provide include:

• The location of the pain
• When the worsening of the pain started
• How often the worsening occurs
• How long the they last
• other symptoms present during severe pain such as eye watering, redness of the eye, nasal blocked, runny nose, being sick and sensitivity to lights, sounds, smell and movement.

If you believe you have these symptoms and have not been diagnosed, you could begin to keep a headache diary and discuss the symptoms with your GP.