Chronic daily bilateral headache responsive to indomethacin

Area of Science:

• Neurology
• Pharmacology

Background:

• Indomethacin is a well-established treatment for specific headache disorders like chronic paroxysmal hemicrania and hemicrania continua.
• Its efficacy in other idiopathic stabbing headaches is less consistent.

Observation:

• Two cases illustrate indomethacin's effectiveness in less common headache presentations.
• Case 1: New-onset chronic daily bilateral headache, aggravated by coughing, responded to indomethacin.
• Case 2: Hemicrania continua, evolving into bilateral continuous pain, remained responsive to indomethacin.

Findings:

• Indomethacin demonstrated significant efficacy in two distinct headache cases.
• The drug successfully managed both chronic daily headache with cough exacerbations and evolving hemicrania continua.
• These cases suggest potential broader responsiveness of idiopathic primary headaches to indomethacin.

Implications:

• Indomethacin may be effective for a wider range of idiopathic primary headache disorders than currently recognized.
• A trial of indomethacin should be considered for primary headaches refractory to conventional therapies.
• This highlights the importance of considering specific pharmacologic agents for challenging headache presentations.