Hemicrania Continua (HC) is a fairly uncommon primary headache disorder (not caused by any other condition) with unrelenting, unilateral head pain that is completely responsive to indomethacin. The symptoms of HC can include, but are not limited to, mild or moderate endless daily head pain, and at least one of the following symptoms:
- runny nose,
- drooping eyelid,
- unusual contraction of the pupil,
- tearing and/or red eyes.
Indomethacin, a nonsteroidal anti-inflammatory drug or NSAID, is used to treat hemicrania continua. Although there is no test to diagnose HC, complete resolution with indomethacin is considered "diagnostic." Unfortunately for some patients, indomethacin and other NSAIDs cannot be taken on a long term basis due to gastrointestinal problems. This currently leaves patients with very few effective options to relieve the pain of HC. However, a study in 2002 showed some success using cyclooxygenase-2 inhibitors² (Celebrex) to treat HC, and in yet another study, a patient was prescribed gabapentin (Neurontin) after having unrelenting HC for 17 years.
A case study of a 42-year-old man who had been suffering with unilateral headache for 12 years and was diagnosed with Migraine is also very interesting. On top of his daily head pain, he had a four-month attack with Migrainous features such as photophobia, nausea, phonophobia and osmophobia. He then had a severe attack (exacerbation), with the additional features of eye tearing, drooping eyelid and feeling as if there were something in his eye. The pain of this attack was extremely severe and lasted several minutes to hours. He was never pain-free on the affected side of his head. He began indomethacin and was headache-free within 36 hours. He continued this therapy for about a week before it had to be stopped due to the stomach issues the medication caused. As soon as the medication was stopped, the pain returned.
The patient was started then started on an initial dose of Melatonin, five mg every night at bedtime, in place of indomethacin. He began to see immediate improvement in pain. His dose was adjusted to seven mg every night at bedtime, and he became headache-free (at the time of the case) for five months. As soon as the melatonin was stopped, the head pain began again in 24 hours.
These cases may be helpful for patients with hemicrania continua to discuss with their doctor if their current regimens are not working. Melatonin, Celebrex and gabapentin may certainly be worth a conversation. Remember, it is up to us to be an active partner in our health care.
Spears, Roderick C. Hemicrania Continua: A Case in Which A Patient Experienced Complete Relief on Melatonin. Headache. 2006;46:524-527.
Thanks for reading and feel well,