Hemicrania Continua - constant pain on one side of your head.

It should always be considered when dealing with someone who complains of a high level of pain, and that pain is located one one side of the head and only on that side of the head.

The moderate-severe headaches can appear in episodes lasting for weeks at a time.

These episodes - relapsing-remitting-type- occur in about 15% of HC cases.

Relapsing-remitting pains can then develop into a more persistent daily headache - which is the case in 32% of cases.

The remainder (>50%) have an unremitting type of headache.

Associated with this headache are migrainous symptoms such as photophobia, nausea or phonophobia. Autonomic features like small pupils (meiosis), lacrimination (watering eye) can occur.

Jabs and jolts of pain - ice-pick type pains are also quite common.

Why is Hemicrania Continua an important diagnosis?

Hemicrania can be mistaken for tension-type headache or even migraine or cluster headache.

However if indomethacin is not administered, the patient will continue to experience headache (unless they are one of the 15% with remitting symptoms).

HC can occur post-partum and is one of the causes of headache during or after pregnancy.

There are single case reports of HC associated with the following conditions.

1. Meningioma of the sphenoid bone
2. HIV infection
3. Lung Adenocarcinoma
4. Carotid dissection

Most cases are without a known cause, and functional MRI studies suggest that there is abnormal activation of the posterior hypothalamus and dorsal - rostral pons.



Patients diagnosed with HC should have brain imaging studies to exclude skull base meningioma and carotid dissection should be considered.

Indomethacin should be given if Hemicrania is considered as a diagnosis.

Usually doses of between 75mg and 225mg daily are needed, and about a quarter of people on this drug will have heartburn which can be relieved by Ranitidine or a Proton-Pump-Inhibitor drug like Lansoprazole.

After treatment for 3 months, indomethacin could be withdrawn to see if remission has occurred.

Melatonin has also been used to treat some cases of HC.

References

Peres MF et al. HC is not that rare. Neurology 2001;57;948-51 (Free Abstract Only)

Rozen TD. Melatonin as treatment for indomethacin-responsive headache syndromes. Cephalalgia 2003; 23: 734–5. (Free Abstract Only)

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