What Is Hemicrania Continua And How Is It Treated?

Hemicrania continua is a type of a headache that lasts long and can be severe

Hemicrania continua (HC) is a headache disorder that’s nothing like a normal headache. The pain is ruthless, lasting anywhere from 20 minutes to days and it mostly affects women in their adult years. Although it’s something as seemingly simple as a headache, hemicrania is often misdiagnosed. Here’s what you need to know about this nervous system disorder to get diagnosed on time.

Symptoms Of Hemicrania Continua

Symptoms of hemicrania continua include a fluctuating pain on one side of the head and migraine symptoms


1. Pain On Only One Side Of The Head

Hemicrania continua is unilateral, i.e., it only affects one side of the head, much like a migraine. Usually, the pain always stays on the affected side and rarely affects both sides of the head.1 But, the possibility is there.2

2. Fluctuating Pain

Daily mild-to-moderate pain is a typical symptom of HC. But this pain is interrupted by more intense, severe episodes (exacerbations) that last for days. These exacerbations vary from person to person.3 For an official diagnosis, such pain needs to be present for at least 3 months without pain-free moments. 4


3. Often Starts In Adulthood

HC is more common in women. Since it usually starts in adulthood, it’s vital to pay attention to the timing of symptoms. However, there is a possibility of HC affecting people anywhere from 5 to 67 years old!5

4. Migraine Symptoms

For some people, HC can cause migraine symptoms like nausea and vomiting. Sensitivity to light and sound are also common, so it might be hard to do daily tasks. Additionally, you might also feel a throbbing pain and sweating on the forehead.6


5. Responsive To Indomethacin

Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are no match for HC. Instead, a doctor might have you take indomethacin, a prescription NSAID. If it works, HC is likely at play.

6. Other Symptoms

For an official diagnosis, at least one of these symptoms should be present:

  • Eye redness and/or tearing
  • Nasal congestion and/or a runny nose
  • Droopy eyelid7
  • Miosis, or excessive constriction of the iris8

What Causes Hemicrania Continua?

The causes of hemicrania continua are unknown, leading to common misdiagnoses

Experts don’t know what causes HC and the risk factors aren’t very clear. This makes it really hard to diagnose! HC is often mistaken for other problems, causing a delay of 7.2 to 8 years of official diagnosis. To be safe, don’t just focus on the exacerbations. Continuous “background pain” is a big sign of HC, so be clear with your doctor. This is key to preventing a wrong diagnosis.


Treatment For Hemicrania Continua

Treatment options for hemicrania continua include indomethacin and COX-2 inhibitors

1. Indomethacin

Doctors usually prescribe indomethacin, starting with 25 milligrams, three times a day. The dose is increased by 25 milligrams every 3 to 5 days, up to 100 milligrams or more. Most people need between 94 and 176 milligrams a day for relief. About 10% of the people feel better within 24 hours, while 43% feel relief within a week.9


2. COX-2 Inhibitors

Indomethacin isn’t safe for long-term use, so your doctor might prescribe COX-2 inhibitors. These are NSAIDs that target cyclooxygenase-2 (COX-2), an enzyme linked to pain and inflammation. Celecoxib and rofecoxib are the two agents used for HC. Unfortunately, COX-2 inhibitors increase the risk for heart problems. So, your doctor might suggest other drugs if you’re at risk.10

3. Reduced Or No Alcohol

For some, drinking alcohol makes the pain worse. Pay attention to the symptoms if you do this often. If the pain becomes more severe, skip alcohol completely.


HC medication often causes tummy trouble. To avoid even more pills, try natural approaches when possible. Drink ginger tea and eat a healthy, well-rounded diet.