Hemicrania Continua (HC)

Persistent headache with a watery, red eye? Read on

Hemicrania continua (HC) is a rare headache disorder, more common in females, usually beginning in adulthood. It always involves head pain on one side only, although rarely it can switch sides.

The pain typically involves the forehead, temple, eye and occipital regions. The pain is present continuously, with frequent worsening, daily or several times a week.

Exacerbations of the pain are associated with tearing, redness of the eye, eyelid drooping, sweating or a runny nose or congestion on the side of the headache, and these are referred to as cranial ‘autonomic’ features.

Patients with HC may become restless and unable to sit still or lie down. The pain when severe can have migraine features such as light and or noise sensitivity, as well as nausea.

There are a few conditions that can mimic HC and an MRI and opthalmological review is essential before the diagnosis can be made. In addition, a diagnostic criterion for HC is an absolute response to Indomethacin (Indocid). This is an anti-inflammatory medication, similar to ibuprofen, however the drug is unique in that it is the only medication that can stop HC.

Most patients can tolerate the drug, however in around 20% of patients side effects limit its regular usage, in particular gastrointestinal side effects, such as gastric ulcers. There are alternative medications that have been trialled with effect, in this scenario, including injection therapy, as can be used with chronic migraines.

HC is a type of primary headache, which your headache specialist will be able to diagnose and treat. In general, it is able to be managed, with patients able to lead normal lives, once an effective regimen has been established, tolerated, and then taken regularly.

Note: Information on this site is not a substitute for professional medical advice.

References:

Hemicrania Continua, Headache, The Journal of Head and Face Pain, Tepper, 2015
Hemicrania Continua Responsive to ‘Injection therapy’ A Case Report, Khalil et al, Headache 2013;53:831-833