About Hemicrania Continua

Overview

Hemicrania continua is a chronic and persistent form of headache characterized by continuous pain that varies in severity and always occurs on the same side of the face and head. It can also cause bilateral pain in some individuals, meaning pain on both sides of the head. Most people with hemicrania continua experience attacks of increased pain three to five times per 24-hour cycle. To be considered hemicrania continua, the person must have a one-sided, daily headache that’s usually moderate but sometimes has short, sharp pains. This needs to have lasted for more than three months, with no breaks from the pain or switching sides. Treatment with the non-steroidal anti-inflammatory drug (NSAID) indomethacin is typically effective in relieving the pain. If indomethacin is not well tolerated, alternative medications can be discussed with a doctor.

Causes and Risk Factors

The exact root causes of hemicrania continua (HC) are still unknown. However, there are some factors that may contribute to the development of this condition. Here is what we know:

Root causes of hemicrania continua:

The hypothalamus (a part of the brain) may become active, which can prevent the normal calming of the nerve system responsible for face and head sensations. The activation of the hypothalamus, with resulting lack of suppression of the trigeminal-autonomic system, has been observed in patients with HC.

Risk factors include:

Biological females are more likely to develop HC than biological males.
HC is typically diagnosed in adults, but it can occur at any age between 5 and 67 years.

Although there is limited information available, alcohol consumption and physical activity have been noted to worsen pain in some people with HC.

It's important to remember that these are general observations and individual experiences may vary. If you have concerns about your specific risk factors or root causes of HC, it's best to consult with a healthcare professional for personalized advice.

Symptoms

The most common early symptom of hemicrania continua (HC) is a dull, continuous headache on one side of the head that lasts for days or weeks. In addition to the continuous headache, individuals with HC may also experience other symptoms, including:

Eye redness or tearing
Miosis (a small pupil)
Nasal congestion
Ptosis (drooping eyelid) or swelling of the eyelid
Runny nose
Forehead or facial sweating
Sensation of fullness in the ear or ear swelling
Sensation of a foreign body in the eye
Swelling of the face
A sensation of post-nasal drip

Some individuals with HC may also experience forehead sweating and migraine-like symptoms such as vomiting, throbbing pain, light and sound sensitivity, and nausea.

It's important to note that HC symptoms can vary from person to person, and not everyone will experience all of these symptoms. If you suspect you may have HC or are experiencing any concerning symptoms, it's best to consult with a healthcare professional for an accurate diagnosis and appropriate management.

Diagnosis

To diagnose hemicrania continua (HC), the following examinations, tests, and procedures are commonly performed:

Physical exam: The healthcare provider will do a physical and neurological exam. They’ll look for signs like pain and swelling and check how well the nerves and other parts of the nervous system are working. This helps them find symptoms that may indicate HC or rule out other causes.
Lab tests: Blood draws or other lab tests may be ordered to check for any abnormalities.
Imaging studies: MRI (magnetic resonance imaging) scans may be recommended to get a closer look at the affected area and to evaluate for any lesions around the pituitary gland.
Clinical procedures: Depending on the symptoms, other specialized tests may be done. An indomethacin trial may be done, as a lack of response to this medication often indicates the headache is unlikely to be HC.

To confirm the diagnosis of HC and assess symptoms characteristics, additional examinations, tests, and procedures may be performed:

Follow-up exams: Regular check-ups with your healthcare provider to monitor your symptoms and progress
Headache diary: Keeping a record of your headaches and their characteristics can provide valuable information for assessing severity.
Pain scales: Using pain scales to rate the intensity of your headaches can help evaluate their severity over time.

It's important to consult with your healthcare provider about which specific examinations, tests, and procedures are most appropriate for your individual situation.

Treatment Options

The main goal is to reduce or eliminate the headache pain associated with HC. The treatment options for HC include:

Indomethacin: This is the most effective medication for treating HC. It is a nonsteroidal anti-inflammatory drug (NSAID) that helps relieve HC pain.
- Acid-suppression medicine: If a person experiences gastrointestinal side effects from indomethacin, a doctor may prescribe acid-suppression medicine to reduce gastrointestinal complications.
- Celecoxib: Another form of NSAID that has fewer side effects compared to indomethacin. It may be prescribed as an alternative if indomethacin is not well-tolerated.
Amitriptyline or other tricyclic antidepressants: These medications can be used as preventive treatments to help reduce the frequency and severity of headache pain in some individuals with HC.
Injections with botulinum toxin and nerve blocks may also help treat hemicrania continua.

Medication dosing may be affected by many factors. Check with your health care professional about dosing for your individual situation. Other side effects can occur. Check with your health care professional or read the information provided with your medication for additional side effect information.