by Elizabeth Linden

 

Hemicrania Continua is a type of trigeminal autonomic cephalalgias (TACs). Trigeminal autonomic cephalalgias are a group of primary headache disorders characterized by one-sided head pain around the eye and forehead. The pain range can range from mild to debilitating. It is similar to other primary headache disorders in some respects, however, it has one distinguishing feature. The pain never stops. 

 

In addition to the pain around the eye and forehead, HC is often associated with one-sided facial features such as:

• dilated blood vessels in the eye

• tears

• nasal congestion

• runny nose

• drooping eyelid

• facial sweating 

 

Getting a diagnosis

Getting a diagnosis of Hemicrania Continua can be a difficult journey for some because HC shares features with other headache disorders such as cluster headaches and migraines. People with HC often see more than one neurologist before reaching a proper diagnosis. To complicate matters, some people can have more than one type of headache disorder making the diagnosis even more difficult. That is why it is essential to create a headache diary to track your symptoms.

 

Diagnosing Hemicrania Continua

In addition to the continual pain and the clinical features stated above, there is another test to diagnose Hemicrania Continua, which is a trial treatment of a drug called indomethacin. If there is a positive response to Indomethacin, it can help confirm the diagnosis (although not all patients respond to this drug). 

 

Treatment

Although Indomethacin is a great diagnostic tool and even treatment for HC, for some, it is not well tolerated as a long-term treatment due to gastrointestinal side effects. Many with Hemicrania Continua eventually have to taper off Indomethacin and use one or more of the treatments listed below. 

 

Other treatments include

• melatonin

• anticonvulsants, such as topiramate

• Celebrex

• corticosteroids

• Amitriptyline

• Lithium

• Gabapentin

• COX-2 inhibitors, such as Celebrex

 

Invasive Treatments

• nerve Stimulation (vagus nerve or occipital nerve stimulation)

• Botox Injections around the head

• sphenopalatine ganglion block, which is an investigational therapy that cuts part of the trigeminal nerve

• deep brain stimulation

 

What to avoid 

The cause of hemicrania continua is still being investigated. Researchers have found that the following activities can aggravate symptoms for many with the disorder:

 

• drinking alcohol

• exercise

• bright light

• changes in sleep patterns 

 

Summary

Hemicrania continua is a chronic daily headache condition that involves one side of your head for more than 3 months at a time. Hemicrania continua will usually respond to the drug indomethacin although this drug is not always well tolerated. Daily medications and self-care are very important for those living with this condition as it can be very challenging for anyone to live in constant pain.

​

​