II. Classification

  1. Long duration
  2. Trigeminal Autonomic Cephalgia
    1. Headaches similar to Cluster Headache
    2. Unilateral trigeminal distribution symptoms with autonomic features

III. 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

IV. 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

V. 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]

VI. Differential Diagnosis

VII. Management

Images: Related links to external sites (from Bing)

Related Studies

Ontology: Hemicrania continua (C2349425)

Concepts Disease or Syndrome (T047)
ICD9 339.41
ICD10 G44.51
SnomedCT 443095000
English hemicrania continua (diagnosis), hemicrania continua, Hemicrania continua (disorder), Hemicrania continua
Spanish hemicrania continua (trastorno), hemicrania continua