Hemicrania continua is not that rare

M. F. P. Peres, MD, S. D. Silberstein, MD FACP;, S. Nahmias, A. L. Shechter, BS, I. Youssef, MD, T. D. Rozen, MD and W. B. Young, MD

From the Jefferson Headache Center (Drs. Peres and Silberstein and A.L. Shechter) and the Department of Neurology (Drs. Rozen and Young and S. Nahmias), Thomas Jefferson University Hospital, Philadelphia, PA; and the Department of Neurology (Dr. Youssef), Temple University Hospital, Philadelphia, PA.

Background:— Hemicrania continua is an indomethacin-responsive headache disorder characterized by a continuous, moderate to severe, unilateral headache. More than 90 cases of hemicrania continua have been reported, but there is still uncertainty about its clinical features.

Methods:— The authors compared 34 new cases (24 women, 10 men) with previously reported cases. All the patients met Goadsby and Lipton’s proposed criteria. The authors compared baseline (continuous background headache) and exacerbation (attacks of severe periods of headaches).

Results:— The baseline headache was typically mild to moderate in intensity and usually not associated with severe disability. In contrast, the headache exacerbations were severe and associated with photophobia, phonophobia, nausea, and disability. At least one autonomic symptom was present in 25 patients (74%). Jabs and jolts were present in 14 patients (41%). The mean indomethacin dose was 136.7 ± 60 mg (range 25 to 225 mg). Twenty-four patients (70.6%) met International Headache Society criteria for migraine in their exacerbation period. Occipital tenderness was observed in 23 patients (67.6%). The temporal pattern was remitting in four patients (11.8%), continuous from onset in 18 (52.9%), and continuous evolving from remitting in 12 (35.3%).

Conclusion:— Hemicrania continua is not a rare disorder. All cases of chronic unilateral daily headaches should receive an indomethacin trial early if not first in treatment.