Hemicrania Continua

Overview

What is hemicrania continua?

Hemicrania continua is a type of headache disorder. It causes constant pain in 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.” It is a primary headache disorder, which means that no other underlying conditions cause these headaches.

What is the difference between hemicrania continua and a migraine?

A hemicrania continua headache and a migraine may cause similar symptoms. In most people, hemicrania continua affects only one half of the face and head. Hemicranial headaches are also constant.

In contrast, migraine symptoms come and go. Migraines can affect any part of your face or head.

What is the difference between hemicrania continua and paroxysmal hemicrania?

Hemicrania continua and paroxysmal hemicrania both affect one side of your face and head. Hemicrania continua causes persistent headaches that rarely or never go away. Paroxysmal hemicrania causes repeated, sudden headaches.

Who might get hemicranial headaches?

Anyone of any age can have hemicrania continua. It is most common in adult women.

Symptoms and Causes

What causes hemicrania continua?

Healthcare providers do not know what causes hemicrania continua. Unlike many types of headache disorders, environmental factors like stress or lack of sleep don’t trigger symptoms.

What are the symptoms of hemicrania continua?

The primary symptom of hemicrania continua is pain concentrated on one side of your face. It may also feel like you have a headache in your eye. This pain is chronic, meaning it doesn’t go away for at least three months.

For some people, hemicrania continua also causes:

Diagnosis and Tests

How is hemicrania continua diagnosed?

A hemicrania continua diagnosis begins when you speak with a healthcare provider about your symptoms. Your provider may ask you to keep a headache trigger diary where you record:

  • What part of your head hurts.
  • When the pain worsens.
  • How long periods of severe pain last.
  • If you have other symptoms, such as nausea or runny nose.

Your provider typically confirms a hemicrania continua diagnosis by evaluating whether your symptoms decrease after taking certain medications. You may also have imaging such as a CT scan or MRI to look at what’s going on in your brain and rule out other headache causes.

Management and Treatment

How is hemicrania continua treated?

The standard treatment for hemicrania continua is a medication called indomethacin (Tivorbex®). Indomethacin is a nonsteroidal anti-inflammatory drug (NSAID). It reduces inflammation. Indomethacin is often the only NSAID that reduces hemicrania continua pain.

Usually, you start by taking a low dose of indomethacin three times daily with meals. If headaches go away, your provider may lower your dose even further. The goal of treatment is to take the lowest dose possible while keeping pain at bay.

Are there side effects of indomethacin?

Most people have no side effects after taking indomethacin. Other people may experience:

Indomethacin can also cause gastrointestinal distress that may lead to ulcers. To prevent ulcers, your provider may prescribe a medication that protects your stomach lining.

Are there other medicines that treat hemicrania continua?

If you can’t tolerate the side effects of indomethacin, your provider may recommend another medicine. Some people take:

  • Celecoxib (Celebrex®), another type of NSAID.
  • Tricyclic antidepressants.

Prevention

How do I know if I’m at risk for hemicrania continua?

You are more likely to develop hemicrania continua if you are female. Although there is no known cause of hemicrania continua, some research has shown that symptoms may be worse if you drink alcohol or exercise excessively. There is no proven way to prevent hemicrania continua.

Outlook / Prognosis

Does hemicrania continua go away?

Hemicrania continua pain may return on and off throughout your life. Some people only ever experience one severe episode of hemicrania continua pain. Others may deal with episodes throughout their lives. Usually, medication reduces pain enough that you can do your usual activities without restriction.

Is there a hemicrania continua cure?

There is no cure for hemicrania continua. Treatment helps many people with hemicrania continua experience little to no disruption in their lives.

Living With

What else should I ask my doctor?

You may also want to ask your healthcare provider:

  • Are there other possible causes of my symptoms?
  • What medication side effects should I watch for?
  • Will I have to take medication for the rest of my life?
  • What alternatives to indomethacin can I try?

A note from Cleveland Clinic

Hemicrania continua is a disorder that causes continuous headaches. Experts don’t know what causes this condition. Unlike other headache disorders, lifestyle or environmental factors don’t trigger the headaches. The primary treatment for hemicrania continua includes taking specific NSAIDs. For most people, medicine reduces symptoms enough to participate in everyday activities.

Last reviewed by a Cleveland Clinic medical professional on 05/06/2021.

References

  • American Migraine Foundation. What to Know about Hemicrania Continua. (https://americanmigrainefoundation.org/resource-library/what-to-know-about-hemicrania-continua/) Accessed 5/17/2021.
  • National Institute of Neurological Disorders and Stroke. Hemicrania Continua Information Page. (https://www.ninds.nih.gov/Disorders/All-Disorders/Hemicrania-Continua-Information-Page) Accessed 5/17/2021.
  • The Migraine Trust. Hemicrania continua. (https://www.migrainetrust.org/about-migraine/types-of-migraine/other-headache-disorders/hemicrania-continua/) Accessed 5/17/2021.

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