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Hemicrania Continua - What Is It?

   
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Hemicrania continua is considered a primary headache disorder, meaning that it's not caused by another condition. It's a rare but treatable disorder. According to the International Headache Society's (IHS) International Classification of Headache Disorders, 2nd Edition, hemicrania continua is a "persistent strictly unilateral headache responsive to indomethacin."

The IHS diagnostic criteria for hemicrania continua is:

Description: Persistent strictly unilateral headache responsive to indomethacin.

.Headache for more than 3 months fulfilling criteria BD

  1. All of the following characteristics:
    1. unilateral pain without side-shift
    2. daily and continuous, without pain-free periods
    3. moderate intensity, but with exacerbations of severe pain
  2. At least one of the following autonomic features occurs during exacerbations and ipsilateral to the side of pain:
    1. conjunctival injection and/or lacrimation
    2. nasal congestion and/or rhinorrhoea
    3. ptosis and/or miosis
  3. Complete response to therapeutic doses of indomethacinNot attributed to another disorder

Hemicrania continua usually presents a mild to moderate daily headache. However, along with the daily, one-sided headache, it also causes exacerbations of more severe headache, which occurs on the same side as the daily headache and is characteristic of Migraine pain. These more severe episodes can last from 45 minutes to days. During these exacerbations, symptoms of other disorders may be present:

  1. Migraine symptoms:
    1. throbbing pain
    2. nausea and/or vomiting
    3. phonophobia
    4. photophobia
  2. Cluster headache symptoms:
    1. conjunctival injection and/or lacrimation
    2. nasal congestion and/or rhinorrhoea
    3. ptosis and/or miosis

The factor that allows hemicrania continua and its exacerbations to be differentiated from Migraine attacks and cluster headaches is that hemicrania continua is completely responsive to indomethacin. Triptans and other abortive medications do not affect hemicrania continua.

The cause of hemicrania continua is unknown. As with Migraine disease and many other headache disorders, there is no definitive diagnostic test for hemicrania continua. Tests such as an MRI may be performed to rule out other causes for the headache. When a patient has the symptoms of hemicrania continua, it's considered "diagnostic" if they respond completely to indomethacin.

_____________
Resources:

International Headache Society. International Classification of Headache Disorders, 2nd Edition.

Tepper, Stewart J., M.D. "Understanding Migraine and Other Headaches." University Press of Mississippi. 2004.

Young, William B., M.D.; Silberstein, Stephen D., M.D. "Migraine and Other Headaches." American Academy of Neurology Press. 2004.

Evans, Randolph W.; Mathew, Ninan T. "Handbook of Headache," Second Edition. Lippincott Williams & Wilkins. 2005.

 

Medical review by John Claude Krusz, PhD, MD

 

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Teri Robert, 2005 - Present. Last updated December 15, 2010.

 

 

 
 
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Anyone interested in the concerns or patients with these disorders is welcome to join.

The AHMA exists to EASE the burden of Migraine and other headache disorders through Education, Awareness, Support, and Engagement.

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NOTE: The information on this site is for education and support only. It is not medical advice and should not be construed as such. Always consult your physician if you have new or different symptoms. Never change your treatment regimen or add herbals, supplements, etc., without consulting your doctor.

All content on this site is physician reviewed by Dr. John Claude Krusz.

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