You’ve always wanted to misdiagnose hemicrania continua, but you haven’t been sure how to do it? You’re in luck! A recent study is bringing to our attention some of the most popular ways to mistreat and misdiagnose this disease, so you can choose your favourite next time a patient comes into your waiting room.
All right – joking aside. I know that doctors do not want to misdiagnose, but for some reason with this one it’s happening. And there’s good reason. When a patient comes into a doctor’s office with a one-sided headache, it’s natural to think it’s migraine.
So what is it?
But hemicrania (one-sided) continua (you know – doesn’t stop) is different. You’ve guessed one reason – it tends to be more steady than migraine. It doesn’t change sides, as migraine pain often does. Also, it doesn’t come and go like a headache from migraine usually would. It stays and doesn’t go away, though it can go from moderate to severe.
Like cluster or migraine, it can be accompanied by congestion, and watery eyes. A shrinking pupil or drooping eyelid is also a common symptom when the pain increases, making it look like cluster.
But, once again, unlike cluster or migraine (usually) the pain is continuous.
And with hemicrania continua, there’s a silver bullet that almost always works: indomethacin (indometacin). Indomethacin is a non-steroidal anti-inflammatory drug (NSAID), sold under brand names such as Indocin, Indorchron E-R, and Indocin S-R.
So with such a good treatment readily available, you may imagine it’s important to get the diagnosis right.
The study in Italy on hemicrania continua, published in February, found that all the patients with hemicrania continua had been given an incorrect diagnosis. Here were the most popular ones:
The reality sets in when we find out what kinds of treatment these patients received. Remember, treatment with indomethacin would have almost certainly been effective.
On average, the patients had tried 3-4 different classes of drugs, most of which were, of course, ineffective. 36% had undergone ineffective invasive treatments as well!
Hemicrania continua is usually listed as a rare condition. But looking at studies like this, it makes you wonder if more people should be trying indomethacin early on in their treatment. It has been argued before that, though not always obvious, hemicrania continua isn’t that rare after all.
If you have a headache that tends to be on one side, this is something you should be talking to your doctor about. An indomethacin trial will rule out the possibility of hemicrania continua, or it might just be the answer.