Hemicrania Continua

What is hemicrania continua?

Hemicrania continua is a type of headache that causes constant pain on only one side of your face and head.

The name “hemicrania continua” comes from Latin words that mean “one side of the head” and “continuous.” For this reason, a hemicrania headache is sometimes called a “side-locked continuous headache.”

It’s a primary headache disorder, which means that no other underlying conditions cause these headaches. A healthcare provider will help you manage symptoms.

What are the types of hemicrania continua?

There are two types of hemicrania continua headaches:

• Chronic: You experience constant daily headaches
• Remitting: Daily headaches continue for up to six months and then stop for a period of time (weeks to months)

What are the symptoms of hemicrania continua?

The main symptom of hemicrania continua is a headache with the following features:

• Head pain on only one side of your head and face (always on the same side)
• Pain that lasts for at least three months
• Pain that feels consistently dull
• Headache attacks (periods of severe, stabbing pain that happen three to five times a day in between constant, dull pain)

You may also have one or more of the following symptoms:

• Drooping eyelid (Ptosis)
• Nausea and vomiting
• Nasal congestion
• Red eyes
• Runny nose
• Sensitivity to light (photophobia) or loud noises
• Tearing

What makes a hemicrania continua headache worse?

If you have a hemicrania continua headache, the pain may feel worse when you:

• Drink alcohol
• Do intense physical activities

Unlike many types of headache disorders, environmental factors like stress or lack of sleep don’t trigger symptoms or make them worse.

What causes hemicrania continua?

Healthcare providers don’t know what causes hemicrania continua. It isn’t caused by an underlying medical condition.

Research suggests hemicrania continua may involve:

• Inflammation in your cavernous sinus (an area in your brain that protects certain blood vessels, nerves and your pituitary gland)
• Widened arteries in your brain
• Trigeminal nerve dysfunction

What are the risk factors for hemicrania continua?

Anyone can have hemicrania continua. But it’s most common in females.

How is hemicrania continua diagnosed?

A healthcare provider will diagnose hemicrania continua after a physical exam and testing. Your provider will ask you questions about how you feel, where the pain in your head is and for how long you’ve had symptoms.

Your provider may ask you to keep a headache diary or notes about your symptoms. It’s a good idea to keep track of:

• The date the headaches occur
• Which part of your head hurts
• When the pain gets worse
• How long periods of severe pain last
• If you have other symptoms, like nausea or a runny nose

Your provider will instruct you to take certain medications to see if they make you feel better. You may also have imaging tests, such as a CT (computed tomography) scan or an MRI (magnetic resonance imaging) scan to take pictures of your brain and rule out other headache causes.

How is hemicrania continua treated?

Treatment for hemicrania continua is a medication called indomethacin. Indomethacin is a prescription nonsteroidal anti-inflammatory drug (NSAID). It reduces inflammation and head pain.

A healthcare provider may prescribe a low dose of indomethacin three times daily. You should take this medication with meals. You should notice symptoms reduce or go away withing a week of starting indomethacin. Some people feel symptom relief as soon as a day after starting treatment.

If headaches go away, your provider may lower your dose. Their goal is to prescribe the lowest dose possible that’s still effective at managing your symptoms.

Side effects of indomethacin

Common side effects of indomethacin include:

• Constipation
• Diarrhea
• Dizziness
• Ringing in ears
• Vomiting

Contact your healthcare provider right away if you experience any serious side effects like:

• Fast heartbeat
• Back pain
• Difficulty breathing or shortness of breath (dyspnea)
• Fever
• Pain while peeing (dysuria)
• Skin rash, itchy skin, hives and/or blisters
• Stomach pain
• Swelling
• Vision changes

What treatments other than indomethacin are available for hemicrania continua?

Indomethacin works for most people, but if you can’t take it, your provider may recommend another medicine like:

• Amitriptyline
• Corticosteroids
• COX-2 inhibitors (celecoxib)
• Gabapentin
• Lamotrigine
• Lithium
• Melatonin
• Naproxen
• Topiramate
• Valproate

Other types of treatment may include:

• Injections of botulinum toxin-A
• Vagus nerve stimulation
• Deep brain stimulation

Can hemicrania continua be prevented?

There’s no way to prevent hemicrania continua. If you have this condition and want to reduce your risk of worsening symptoms, avoid drinking alcohol and overexerting yourself during physical activities.

What’s the outlook for hemicrania continua?

Hemicrania continua is a treatable type of headache. A healthcare provider can help you manage symptoms and adjust the dosage of prescription medications as needed throughout your life. You might experience headache episodes (periods when headaches return) after months of being symptom-free. Many people report that they’re able to get back to their routine without restriction when managing headaches with indomethacin medication or an alternative medication.

Is hemicrania continua serious?

Hemicrania continua isn’t a dangerous or life-threatening condition. It isn’t a sign of an underlying condition or an indication that something more serious is causing head pain.

It can be alarming to experience hemicrania continua headaches if you don’t know what’s causing them. Your symptoms will feel very serious. A healthcare provider will diagnose what’s causing constant headaches to help you manage them.

What can I expect if I have hemicrania continua?

This headache is persistent. It can interfere with your ability to think clearly and feel like yourself. Living in pain can be frustrating, especially when you’re trying to make it through your routine. It can feel like you’re working twice as hard to do simple activities. This can have a serious impact on your mental health and emotional well-being.

When should I see a healthcare provider?

Let a healthcare provider know if you have headaches that feel like they never end.

If you have hemicrania continua, talk to your provider if you experience new or worsening symptoms or notice any side effects from the medication you take.

What questions should I ask my healthcare provider?

• What type of treatment do you recommend?
• Which medication side effects should I watch for?
• Will I have to take medication for the rest of my life?

What is the difference between hemicrania continua and paroxysmal hemicrania?

Hemicrania continua and paroxysmal hemicrania both affect one side of your head. Hemicrania continua causes persistent headaches. Paroxysmal hemicrania causes repeated, sudden headaches.

What’s the difference between a hemicrania continua headache and a migraine?

A hemicrania continua headache and a migraine may cause similar symptoms. In most people, hemicrania continua affects only one side of your face and head. They’re also constant and happen daily. Migraine symptoms come and go. Migraines can affect any part of your face or head.