# Hemicrania continua | Symptoms, Causes, Tests and Treatment | OSANG > Continuous hemicrania is a headache in which a more severe exacerbation phase overlaps the underlying pain that persists on one side, and the exacerbation phase is accom… - Official page: https://osns.co.kr/en/encyclopedia/hemicrania-continua - Organization: OSANG Neurosurgery ## Page content Headache ## Hemicrania continua Hemicrania Continua · G44.51 Hemicrania continua is a headache that continues uninterruptedly on one side of the head. It is accompanied by ipsilateral autonomic symptoms during the exacerbation period and is a trigeminal autonomic headache that absolutely responds to indomethacin. ## At a glance Continuous hemicrania is a headache in which a more severe exacerbation phase overlaps the underlying pain that persists on one side, and the exacerbation phase is accompanied by restlessness and autonomic symptoms such as ipsilateral conjunctival injection, tearing, nasal congestion, and drooping eyelids. Absolute and complete response to indomethacin is included in the ICHD-3 diagnostic criteria. In one clinical study, approximately 68% of patients had paroxysmal exacerbations. Be aware of gastrointestinal side effects and use a gastroprotectant together with long-term use. - 01Definition and Overview - 02symptoms - 03diagnosis - 04treatment - 05Clinical implications ## Definition and Overview Hemicrania continua is a one-sided headache that is closely related to trigeminal autonomic cephalalgias, and is characterized by pain that continues uninterrupted on one side. Pain appears fixed to one side, left or right, and usually does not change sides. Normally, mild to moderate baseline pain persists, and then a more severe exacerbation period appears on top of it. The exacerbation phase is accompanied by ipsilateral autonomic symptoms. Absolute response to indomethacin is the key to diagnosis. ## symptoms ### pain pattern - Persistent underlying pain on one side: Uninterrupted, one-sided headache - Exacerbating stage: More severe pain appears on top of the underlying pain for tens of minutes to several days. - Pain location: fixed on one side of the forehead, around the eye, or temporal area ### Autonomic symptoms (ipsilateral) During the worsening phase of pain, ipsilateral conjunctival injection, tearing, nasal congestion or runny nose, ptosis, and miosis appear. In one clinical study, approximately 68% of patients showed a distinct paroxysmal exacerbation phase, and complaints of restlessness (agitation) were common during the exacerbation phase. ## diagnosis The diagnosis of persistent hemicrania is a clinical diagnosis according to the International Classification of Headache Disorders, Third Edition (ICHD-3) criteria. Diagnostic criteria include unilateral headache lasting more than 3 months, ipsilateral autonomic symptoms or restlessness, and complete response to therapeutic doses of indomethacin. It is characterized by the fact that absolute response to indomethacin itself is included in the diagnostic criteria. The diagnosis is confirmed when pain completely disappears after indomethacin test administration. Because it is a unilateral fixed headache, it is recommended to rule out secondary causes with a brain MRI. ## treatment ### indomethacin Indomethacin is the first-line treatment and serves both diagnosis and treatment. Maintain the lowest dose that completely controls pain. ### Side Effect Management Indomethacin is a non-steroidal anti-inflammatory drug that has a risk of side effects such as gastrointestinal bleeding, stomach ulcers, and decreased renal function. When taking it for a long time, use a gastroprotective agent such as a proton pump inhibitor and check renal function periodically. ### alternative drugs When it is difficult to use indomethacin, other non-steroidal anti-inflammatory drugs, topiramate, melatonin, etc. are tried, but the consistency of effect is not as good as indomethacin. ## Clinical implications If ipsilateral autonomic symptoms are observed in a headache that persists and is fixed on one side, hemicrania continuum should be suspected and a trial of indomethacin should be considered. Because drug response determines diagnosis, appropriate dose and sufficient duration of testing are important. ## Frequently asked questions ### Q01What type of headache is hemicrania persistent? A persistent headache on one side of the head. Normally, moderate baseline pain persists, followed by a more severe exacerbation phase, which is accompanied by restlessness and autonomic symptoms such as tearing, conjunctival injection, and nasal congestion. The characteristic feature is that the pain is fixed to only one side, right or left. ### Q02Why is it important to respond to indomethacin? A complete and absolute response to indomethacin itself is included in the diagnostic criteria for hemicrania persistent. The diagnosis is confirmed when the pain completely disappears when an appropriate dose of indomethacin is used. If there is no response, another headache is suspected. A headache in which a drug reaction has diagnostic significance. ### Q03Is it okay to take indomethacin for a long time? Indomethacin is a non-steroidal anti-inflammatory drug and has a risk of gastrointestinal side effects such as gastrointestinal bleeding and gastric ulcers. If long-term use is necessary, use gastric protectors (proton pump inhibitors) together and check renal function periodically. Do not adjust the dosage on your own; take it according to the instructions of a specialist. ### Q04How is it different from cluster headache? Cluster headaches involve repeated attacks of 15 minutes to 3 hours during the cluster period, but hemicrania continuum is different in that the pain continues uninterrupted. Additionally, hemicrania persistent is absolutely responsive to indomethacin, whereas cluster headache is not. ### Q05Is persistent hemicrania also necessary? For persistent headaches that are fixed on one side, it is necessary to rule out secondary causes such as brain tumors and vascular malformations, so imaging tests such as brain MRI are recommended. Even if a patient responds to indomethacin, consider additional evaluation if there are atypical patterns. ### Q06Are there any other treatments besides indomethacin? If indomethacin is difficult to use, other non-steroidal anti-inflammatory drugs, topiramate, and melatonin are tried. However, since it does not show as consistent an effect as indomethacin, the primary treatment is indomethacin. ## Related articles - giant cell arteritis - Hypnic Headache - Idiopathic intracranial hypertension - paroxysmal hemicrania This article provides general medical information and does not replace an individual diagnosis or treatment plan. Please seek a medical assessment if symptoms persist. ## Important notice This Markdown alternative helps search and AI tools understand the public page accurately. It provides general health information and does not replace an individual diagnosis or treatment.