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Hemicrania Continua

Hemicrania continua, or continuous headache, is a rare type of headache that doesn't stop.

The pain is felt on one side of the face or head. It varies in severity.

Patients with hemicrania continua describe a dull ache or throb that is interrupted by periods of pain that is:

  • jolting
  • sharp
  • stabbing

These attacks usually happen three to five times a day.

Some patients will have these headaches steadily for months or years. In others, the pain will go away for weeks or months. But then it returns for extended periods.

Doctors consider a diagnosis of hemicrania continua if the pain has been present, without switching sides or disappearing even briefly, for at least three months.

The cause of hemicrania continua headaches is unknown. They affect women more often than men.

Fortunately, this condition can be treated. Patients who are able to tolerate daily anti-inflammatory medications achieve near-complete to complete relief.

Hemicrania Continua Symptoms

Hemicrania continua headaches often share features of other kinds of headaches. This overlap of symptoms can make them tricky to diagnose.

Like migraines, they may cause:

  • Nausea or vomiting
  • Aversion to noise or light
  • Throbbing

Hemicrania continua also shares features of cluster headaches. For example, people with hemicrania continua may have problems with involuntary nervous system functions. Those symptoms, which occur on the affected side of the face and head, may include:

  • Stuffy or runny nose 
  • Nosebleeds (rarely)
  • Tearing, redness, or irritation of the eyes
  • Drooping eyelids
  • Sweating

Symptoms may be aggravated by many factors, including:

  • Stress
  • Irregular sleep
  • Bright lights
  • Fatigue
  • Physical exertion or exercise
  • Alcohol

In about 10% of patients, an attack may be triggered by:

  • Applying pressure to the neck
  • Flexing or rotating the neck

Treatment of Hemicrania Continua

Hemicrania continua headaches respond well to some anti-inflammatory medications. Indomethacin, a nonsteroidal anti-inflammatory drug (NSAID), often provides rapid relief. Doctors consider it a telltale sign of hemicrania continua if the headaches go away after a dose of the drug. However, patients may need special testing -- such as an MRI -- as part of their evaluation.

Daily doses of indomethacin for hemicrania continua typically range from 25 to 300 milligrams. A common side effect of the drug is irritation of the lining of the stomach and gastrointestinal tract. So patients taking indomethacin may also need acid-suppressing medication.

For patients who can't tolerate indomethacin's side effects, another NSAID, celecoxib, may also help. 

Tricyclic antidepressants, like amitriptyline, are also useful as a preventive treatment.

WebMD Medical Reference

Reviewed by Scott Keller, MD on March 28, 2014
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