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Rigorously defined hemicrania continua presenting bilaterally

Andrew M Southerland1, Ivan S Login

  • 1University of Virginia Health System, Charlottesville, 22908, USA. as5ef@virginia.edu

Cephalalgia : an International Journal of Headache
|August 2, 2011
PubMed

Insights

Hemicrania continua (HC), a continuous headache disorder, can present bilaterally. This case highlights that a bilateral headache with autonomic features may respond completely to indomethacin, suggesting it is a viable treatment option.

Area of Science:

  • Neurology
  • Headache Medicine

Background:

  • Hemicrania continua (HC) is a primary headache disorder defined by continuous unilateral pain, autonomic symptoms, and indomethacin responsiveness.
  • HC shares features with trigeminal autonomic cephalalgias and chronic daily headaches like chronic migraine.
  • Diagnostic delays in HC occur due to low incidence and phenotypic variability.

Observation:

  • A 62-year-old woman experienced 5 months of continuous bilateral headache with autonomic symptoms.
  • Neurological exams and imaging were unremarkable.
  • The patient failed multiple treatments before responding to indomethacin.

Findings:

  • This case illustrates that hemicrania continua can manifest as a purely bilateral headache.
  • The patient achieved complete pain resolution and remission with indomethacin treatment.

Implications:

  • Bilateral headache presentations should be considered within the spectrum of hemicrania continua.
  • A therapeutic trial of indomethacin is warranted for bilateral headaches with autonomic features meeting HC criteria.
  • This case expands the understanding of HC's clinical presentation and diagnostic considerations.
Abstract

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