From the Research
Hemicrania treatment should prioritize indomethacin as the first-line treatment, given its effectiveness in managing hemicrania continua and paroxysmal hemicrania, as supported by the most recent and highest quality study 1.
Treatment Options
- Indomethacin (25-50mg three times daily) is specifically effective for hemicrania continua and paroxysmal hemicrania, with a good safety and tolerability profile, especially when the dose is reduced over time 2.
- For acute treatment of hemicrania continua, piroxicam and celecoxib have shown good results, while for prolonged treatment, celecoxib, topiramate, and gabapentin are good options besides indomethacin 1.
- In cases where indomethacin is not tolerated, alternatives such as verapamil, acetylsalicylic acid, and naproxen may be considered, although their efficacy may vary 3.
Key Considerations
- Treatment should be tailored to the specific type of hemicrania, frequency of attacks, and individual response.
- Lifestyle modifications, such as maintaining regular sleep patterns, avoiding alcohol, and identifying food triggers, can complement medication.
- Nerve blocks or neuromodulation devices may be considered for refractory cases.
Recent Findings
- A case report suggests that combining low-dose indomethacin with pregabalin can be an effective treatment strategy for hemicrania continua, allowing for a reduction in indomethacin dose and minimizing side effects 4.
- A systematic review highlights the importance of considering hemicrania continua in the differential diagnosis of continuous headache and the need for further studies to define the treatment of choice for this condition 5.