From the Research
Hemifacial hemicrania, also known as hemicrania continua, is a chronic headache disorder that should be treated with indomethacin as the first-line treatment, starting at 25 mg three times daily and gradually increasing to 75-150 mg daily as needed for pain control, as it provides a diagnostic response and is characteristic of this condition. This condition is characterized by continuous, one-sided head pain with occasional flare-ups of more intense pain, and it is believed to involve trigeminal nerve dysfunction and abnormal activation of the trigeminovascular system, explaining why the anti-inflammatory properties of indomethacin are particularly effective for this specific type of headache 1.
Some key points to consider in the treatment of hemifacial hemicrania include:
- The use of indomethacin as the first-line treatment, with a gradual increase in dose as needed for pain control 2, 1
- The addition of a proton pump inhibitor like omeprazole 20 mg daily for patients who cannot tolerate indomethacin due to gastrointestinal side effects
- Alternative treatments such as COX-2 inhibitors like celecoxib, gabapentin, melatonin, or nerve blocks in refractory cases 3, 4, 5
- The importance of consistent medication use and regular follow-up with a healthcare provider to monitor for side effects and adjust treatment as needed
It is also important to note that hemifacial hemicrania is often misdiagnosed and underreported, with a pooled mean delay of diagnosis of 8.0 ± 7.2 years, and that it represents 1.7% of total headache patients attending headache or neurology clinic 1. Therefore, a thorough diagnosis and treatment plan are crucial to effectively manage this condition and improve patient outcomes.