Why is it important to diagnose hemicrania continua?

Abstract

Hemicrania continua (HC) is an indomethacin-responsive primary headache which belongs to the trigeminal autonomic cephalalgias. Although the first description of HC was 35 years ago, there are still different views regarding the clinical course, the diagnostic criteria, and the treatment. The high clinical heterogeneity of HC, missed diagnosis, and the delay to the correct diagnosis are important in patient care. Central features of HC are continuous side-locked headaches (with superimposed exacerbations) and the response to indomethacin. We are describing the case of a 29-year-old women who developed right-sided headache 3 weeks after the excision of a right-sided vestibular schwannoma. She tried different painkillers and also was started on a prophylactic treatment with oxcarbazepine, acupuncture, and physiotherapy. But nothing really helped. She was then admitted for an inpatient withdrawal program for medication overuse headache. Again the pain did not change. She has then been treated with indomethacin 50-mg tds, where after the headache improved rapidly within 3 days. This educational case presentation and review of the literature aims to consider HC as a possible differential diagnosis in chronic headache, especially when side-locked and shows that indomethacin maybe a quick therapeutic option before putting the patients on a long treatment odyssey with analgesics and other drugs.