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Hemicrania Continua Headaches

What Are They and What Should You Know?

By Betsy Lee-Frye

Updated February 13, 2009

(LifeWire) - According to the International Classification of Headache Disorders, a hemicrania continua headache is a subtype of chronic headache. Most patients with hemicrania continua headaches report pain more than 5 times in a 24-hour period and at least 15 times a month.

By definition, hemicrania continua occurs on just one side of the head. The chronic pain is generally continuous and fluctuates in intensity. In some cases, the pain is further exacerbated by sharp, jabbing pain on the same side. However, several recent studies report individuals who have hemicrania continua pain that moves between each side of the head during one headache episode.

Hemicrania continua can be one of the most debilitating headache types experienced by migraine sufferers. The cause is unknown, but there are some treatment options.

Symptoms and Diagnosis of Hemicrania Continua

In one case study published by the Mayo Clinic, a woman named Sharon described her headache pain like this, "All I could do was lie in the dark and pray that God would take the pain away."

In Sharon's case, the pain associated with hemicrania continua headaches started on one side of her head, eventually moving into her neck, shoulders, back and then her face. She told physicians that at times the pain was so severe it caused her to pass out.  Sharon's experience is similar to those of many people with hemicrania continua headaches.

In addition to chronic pain, symptoms of the disorder include runny nose, tearing and redness of the eyes, sweating, drooping eyelids, nausea, vomiting and sensitivity to light.

Who Experiences Hemicrania Continua?

It is unknown how prevalent hemicrania continua headaches are among the public. Chronic headaches, the larger classification, affect 4 to 5% of the general population. Other chronic headache subtypes include transformed migraine, chronic tension-type headache and new daily persistent headache. Among those who suffer from chronic headaches, a 5-year study of 651 headache sufferers found that 2.2% of these study participants experienced hemicrania continua headache pain.

Researchers have found that hemicrania continua headaches, like migraine headaches, are more common among women. In addition, research indicates that exercise and alcohol consumption can worsen headache symptoms.

What Causes Hemicrania Continua?

Hemicrania continua is so rare that few studies have been conducted to investigate the cause. One recent case study found a connection between hemicrania continua and brain-stem lesions. In this case, a 47-year-old woman presented with a 3-year history of hemicrania continua headaches on the right side. After conducting a brain scan using a MRI, her physicians found a right-side brain stem lesion. The doctors also concluded that the woman's headaches were preceded by a stroke. However, case studies of other patients indicate normal brain scans. Therefore, this case study is by no means conclusive.

Treating Hemicrania Continua

One commonly prescribed treatment for hemicrania continua is indomethacin, an anti-inflammatory oral medication. Hemicrania continua headaches are referred to as indomethacin responsive, meaning in most cases the symptoms are eliminated after several doses of the drug. However, as with other anti-inflammatory medications, the side effects of indomethacin often preclude long-term usage. In fact, 25% to 50% of patients on indomethacin therapy eventually develop the gastrointestinal side effects commonly caused by this medication, including abdominal pain, stomach ulcers and intestinal bleeding. Other side effects may include excessive fatigue, unexplained bruising or bleeding, blurred vision, ringing in the ears and chronic constipation.

Although no medication has been proven to treat hemicrania continua headaches as effectively as indomethacin, new research has uncovered other treatment options.

Several case studies have demonstrated that the herbal supplement melatonin could be a promising alternative therapy. Available over-the-counter melatonin has a chemical structure similar to indomethacin, but it is found naturally in the body. One case study indicated a 7-mg supplement at bedtime completely relieved symptoms for this individual. However, the herbal supplement is not subject to approval by the FDA and -- as with any medical condition -- patients should consult their healthcare provider before beginning any therapy.  According to the National Institutes of Health, side effects may include dizziness, mood changes, increased risk of seizure, decreased sperm count among men, decrease in blood pressure and increased blood sugar levels.

Researchers have also found the prescription drug topiramate to be a promising treatment. Topiramate is an anticonvulsant medication that reduces irregular brain activity. Although several small case studies have found the medicine beneficial, larger studies are needed to learn whether the benefits of the drug outweigh the potential side effects, which include dizziness, inability to concentrate, confusion, increased risk of kidney stones and increased risk of osteoporosis. In addition, topiramate can cause difficulty for a person to sweat.

As with any medication regiment, care should be taken to follow your doctor's orders. Missing doses can lead to a "rebound effect." This refers to a resurgence of headache symptoms as soon as the medication is out of the bloodstream. If the side effects of a medication become troublesome, patients should consult with their healthcare provider before stopping treatment.

Sources:

Brighina, F., A. Palermo, G. Cosentino, B. Fierro. "Prophylaxis of Hemicrania Continua: Two New Cases Effectively Treated with Topiramate." Headache 3.47 (March 2007): 441-443.  <www.ncbi.nlm.nih.gov/pubmed/17371364?ordinalpos=9&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum>.

"Hemicrania Continua." NINDS Hemicrania Continua Information Page. 7 Apr. 2008. National Institute of Neurological Disorders and Stroke.  7 Apr. 2008. <www.ninds.nih.gov/disorders/hemicrania_continua/hemicrania_continua.htm>.

"Indomethacin." Medline Plus. 1 Aug. 2007 National Institutes of Health. 3 Apr. 2008. <www.nlm.nih.gov/medlineplus/druginfo/medmaster/a681027.html>.

Krymchantowski, Abouch Valenty. "Primary Headache Diagnosis Among Chronic Daily Headache Patients." Arquivos de Neuro-Psiquiatria 61.3 (June 2003)  <www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2003000300008>.

"Melatonin." Medline Plus. 1. Aug. 2006. National Institutes of Health. 3 Apr. 2008. <www.nlm.nih.gov/medlineplus/druginfo/natural/patient-melatonin.html>.

Sharon Francis: A Telling Pain." Annual Report 2004. 2004. Mayo Clinic. 11 Apr 2008 <www.mayoclinic.org/annualreport/sharonfrancis-2004.html>.

Spears, R.C. "Hemicrania Continua: A Case in Which a Patient Experienced Complete Relief on Melatonin." Headache 46.3 (March 2006): 524-527. <www.ncbi.nlm.nih.gov/pubmed/16618278?ordinalpos=28&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum>.

"Topiramate." MedMaster Patient Drug Information. 1 Aug. 2006. American Society of Health-System Pharmacists.  <www.ncbi.nlm.nih.gov/books/bv.fcgi?log$=drug_bottom_one&rid=medmaster.chapter.a697012>.

Turner, Ira. "Hemicrania Continua." Headaches.org. July/August 2007. National Headache Foundation. 3 Apr. 2008. <www.headaches.org/education/NHF_Head_Lines_Excerpts/Case_Studies_in_Headache_Archive/CS_157>.

Valença, Marcelo, Luciana P. A. Andrade-Valença, Wilson Farias da Silva and David W. Dodick. "Hemicrania Continua Secondary to an Ipsilateral Brainstem Lesion." Headache: The Journal of Head and Face Pain  47.3 (March 2007): 438-441. <www.blackwell-synergy.com/doi/abs/10.1111/j.1526-4610.2007.00732.x>.

LifeWire, a part of The New York Times Company, provides original and syndicated online lifestyle content. Betsy Lee-Frye is an independent journalist living in Kansas City, Mo. Her work has appeared in the "Dallas Morning News," "Better Homes and Gardens Special Interest Publications" and the "St. Joseph News-Press."

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