What is a hemicrania continua?
Hemicrania continua is a chronic, continuous headache that varies in severity. Occasionally it can involve both sides but the majority have pain on only one side of the face and head. Like paroxysmal and chronic paroxysmal hemicrania, hemicrania continua falls into the category of “indomethacin responsive headaches.” Hemicrania continua is characterized by a constant daily headache of mild to moderate intensity, with episodes of severe pain which can last from an hour to days. These exacerbations have a migraine type quality and are quite debilitating. In some instances, the head pain of hemicrania continua can dissipate for as long as 6 months before reoccurring.
Other symptoms on the same side of the headache include:
- Eye watering and redness
- Nasal congestion or runny nose
- Decreased size of pupil
- Eyelid swelling and/or drooping
- Forehead perspiration
Other general symptoms include:
- Light sensitivity
- Nausea with or without vomiting
- Slow/fast heart rate
How is hemicrania continua diagnosed?
The diagnosis of hemicrania continua is made by a taking a detailed history and preforming a careful examination. Hemicrania continua cannot be diagnosed solely with imaging studies or blood tests. Since an underlying structural abnormality such as a tumor or vascular malformation can mimic the pain of hemicrania continua, your physician may order imaging studies to exclude these conditions. Occasionally, hemicrania continua can be the result of neck problems from trauma or arthritis and can be treated in a similar manner as a cervicogenic headache.
How is hemicrania continua treated?
By definition, hemicrania continua always responds to the non- steroidal anti-inflammatory drug, indomethacin (hence it’s classification within the family of indomethacin responsive headaches) which is carefully monitored for potential gastrointestinal and kidney side effects. If it is not tolerated, there are a number of other medications which can be prescribed, many of which are also used to treat migraines.
Can Interventional Headache Management help with hemicrania continua?
If you have had a thorough examination, prior medical care and medications and appropriate imaging studies and continue to have headaches which disrupt your regular activities, Interventional Headache Treatment may be an effective way to manage your pain. Through injection procedures, Interventional Headache Treatment can be used to identify the structures or nerve pathways which are causing or contributing to your headache. In some instances this can include the sphenopalatine ganglion, or one of the cervical structures. Once identified, radiofrequency procedures can be used to provide sustained relief. This and other treatment options will be discussed as part of your initial consultation.