From the Research
Hemicrania continua is a rare, chronic headache disorder that should be treated with indomethacin, starting at 25mg three times daily, as it is the most effective treatment option, with a response rate of nearly 100% 1. The diagnosis of hemicrania continua requires a comprehensive evaluation, including a thorough medical history and physical examination, to rule out other potential causes of headache. The condition is characterized by continuous, unilateral head pain, often accompanied by autonomic symptoms such as lacrimation, conjunctival injection, and restlessness or agitation. Some key points to consider in the diagnosis and treatment of hemicrania continua include:
- The importance of indomethacin in the treatment of hemicrania continua, with doses ranging from 25mg to 300mg daily, depending on the patient's response and tolerance 2, 3, 4
- The need for gastric protection with a proton pump inhibitor, such as omeprazole, to prevent gastrointestinal side effects associated with indomethacin therapy 2, 3
- The potential for alternative treatments, such as COX-2 inhibitors, gabapentin, melatonin, or nerve blocks, in patients who cannot tolerate indomethacin or have contraindications to its use 3, 4
- The importance of a thorough diagnostic evaluation to rule out other potential causes of headache and to confirm the diagnosis of hemicrania continua 1 It is essential to note that hemicrania continua is often misdiagnosed as migraine or cluster headache, but its absolute response to indomethacin is a distinguishing diagnostic feature. In terms of treatment, indomethacin is the first-line treatment option, and its effectiveness has been consistently demonstrated in various studies, including a recent update on the condition 1. Alternative treatments, such as pregabalin, may be considered in patients who cannot tolerate indomethacin or have contraindications to its use, as demonstrated in a case report where the combination of low-dose indomethacin and pregabalin was effective in treating hemicrania continua 4. Overall, the diagnosis and treatment of hemicrania continua require a comprehensive approach, taking into account the patient's medical history, physical examination, and response to treatment, as well as the potential for alternative treatments in patients who cannot tolerate indomethacin.