Headaches- One of the most annoying and disabling condition of the human body. When headaches strike, they generally render an individual incapacitated forcing that individual to be bedridden and incapacitated till the time the headache lasts. Sometimes, the headaches can become chronic making an individual dependent on medications long term for headache management. There are many forms of headaches like migraines, etc. One such condition is Hemicrania Continua. In this article, we will go in depth about the causes, symptoms, and the ways to manage them.
How Do We Define Hemicrania Continua (HC)?
Hemicrania Continua is a rare type of chronic headache which is marked by continuous pain on one side of face with varying degrees of severity. There may be severe attacks of pain which may come along with these varying but continuous pains. There are two main categories of symptoms of Hemicrania Continua that are autonomic which include runny nose, tearing from the eye, eye discomfort, drooping of eyelids and the second category is the more migrainous-like which include nausea, vomiting, and photophobia etc. Hemicrania Continua has basically two forms i.e., continuous in which there are daily headaches, and remitting in which headaches may occur for a period of a few months followed by a headache free period of a few weeks and then the cycle resumes. Most people with Hemicrania Continua have attacks of increased pain about two to four times a day. Hemicrania Continua is found more in females than males. Hemicrania Continua may be increased in some individuals with physical activity or alcohol use.
Causes of Hemicrania Continua (HC)
There is no known cause of Hemicrania Continua, neither are there any definitive tests to diagnose it. Studies may be done to rule out other causes of headache. The major factor that differentiates Hemicrania Continua from other migraine disorders is that Hemicrania Continua is treated completely by taking indomethacin.
Symptoms of Hemicrania Continua (HC)
Apart from the daily headache due to Hemicrania Continua, which is generally mild-to-moderate, there may be other symptoms as well which are associated with Hemicrania Continua. They are divided into three main categories:
- Autonomic Symptoms: To include conjunctival injection, tearing, rhinorrhea, forehead sweating.
- Stabbing Headaches: To include acute throbbing headaches over and above the persistent daily headache lasting less than one minute.
- Migrainous Features: To include excruciating pain along with nausea, vomiting, phonophobia and photophobia.
How Is The Diagnosis Of Hemicrania Continua (HC) Confirmed?
If an individual fulfils the following diagnostic criteria then, the diagnosis of Hemicrania Continua is confirmed:
- Headaches for more than three months with the above mentioned salient features.
- Unilateral pain
- Daily headaches without pain-free periods
- Moderate intensity headaches with periods of exacerbations of intense pain
- Conjunctival injection
- Nasal congestion.
Treatment for Hemicrania Continua (HC)
The only successful treatment for Hemicrania Continua is the use of indomethacin at a dose of about 25 mg titrating up to 300 mg daily continued long term. Gastrointestinal upset is a common side effect of this drug hence GI prophylaxis is to be followed when using this medication. If an individual is unable to tolerate indomethacin, then the individual is given a drug called Celebrex at 400 to 800 mg per day.