Hemicrania Continua

Aka: Hemicrania Continua

1. See Also
   1. Cluster Headache
   2. Paroxysmal Hemicrania
   3. Short-Lasting Unilateral Neuralgiform Headache Attacks with Conjunctival Injection or Tearing (SUNCT Headache)
   4. Headache
   5. Headache Red Flag
   6. Organic Headache
   7. Chronic Daily Headache
2. Classification
   1. Long duration
   2. Trigeminal Autonomic Cephalgia
      1. Headaches similar to Cluster Headache
      2. Unilateral trigeminal distribution symptoms with autonomic features
3. Symptoms
   1. Characteristics
      1. Unilateral Headache
   2. Associated symptoms (at least one of the following cluster-like autonomic findings)
      1. Conjunctival injection or Lacrimation
      2. Nasal congestion or Rhinorrhea
      3. Ptosis or Miosis
   3. Palliative measures
      1. Responds completely to Indomethacin
4. Imaging
   1. MRI Brain with and without contrast
      1. Recommended for all Trigeminal Autonomic Cephalalgia including Cluster Headaches
      2. Obtain even if no other Headache Red Flag present
5. Diagnosis
   1. Unilateral Headache of moderate or greater severity Headaches for at least 3 months
   2. At least of the following (ipsilateral to the Headache, other than restlessness)
      1. Conjunctival injection or Lacrimation
      2. Nasal congestion or Rhinorrhea
      3. Eyelid Edema
      4. Forehead and facial sweating
      5. Miosis or Ptosis
      6. Restlessness or Agitation
   3. Responds to therapeutic doses of Indomethacin
      1. Indomethacin 150 to 225 in divided doses per day
   4. Timing
      1. Remitting
         1. Remission periods of >24 hours
      2. Unremitting
         1. Daily and continuous Headache >1 year without remission periods >24 hours
   5. References
      1. (2018) Cephalgia 38(1):1-211 [PubMed]
6. Differential Diagnosis
   1. See Cluster Headache
7. Management
   1. Indomethacin
8. References
   1. (2004) Cephalgia 24(suppl 1): 9-160 [PubMed]
   2. Yancey (2014) Am Fam Physician 89(8): 642-8 [PubMed]