Unilateral Facial Pain and Headache: Effects of Both Indomethacin and Sumatriptan

Abstract

Three female patients presented with a similar pattern of unilateral facial pain and headache, reminiscent of atypical facial pain. The neck and ipsilateral shoulder (n=2) were also involved. The attacks of pain lasted from several hours to days. There was some tenderness in the neck, but upper cervical nerve anesthetic blocks did not provide any positive results. Indomethacin, taken at the time of the attacks, exerted a very marked effect. Sumatriptan produced an even more rapid and complete effect, but with intolerable side effects, including malaise and breathing difficulties. The unilateral facial pain and headache described in these cases resembles both cervicogenic headache (CEH) and hemicrania continua (HC), especially the former, which may be associated with both facial and shoulder pain. Indomethacin is, however, generally not effective in CEH. A clear sumatriptan effect in the cases studied is remarkable because there is usually little or no sumatriptan effect in HC. Atypical facial pain is difficult to treat, and probably does not respond well to indomethacin. The present study found that some patients with a similar symptomatology may benefit from indomethacin. The demonstrated effectiveness of indomethacin or sumatriptan makes it important to recognize such cases. Future serotonin agonists may have a more favourable effect to side effect ratio than sumatriptan and provide a more ideal approach to therapy in such cases.