Hemicrania continua

10 June 2014

Hemicrania Continua: Is Melatonin an Alternative to Indomethacin?

James Discoveries & Stats, Medications, Treatments 8

If you’ve never heard of hemicrania continua, you’re already lost. If you have hemicrania continua, you know exactly what I’m talking about.

Briefly, for the fortunate ones who don’t have this condition, hemicrania continua is a constant one-sided headache which is often accompanied by watery eyes and congestion. It’s often misdiagnosed as migraine or sinus headache. For more quick info, see Hemicrania Continua Facts.

There are some unique things about this condition. For example, the headache is always one-sided. And although it may wax and wane, the headache is always there.

But for our purposes, the important thing is that it it treated with indomethacin, a non-steroidal anti-inflammatory drug (NSAID) (similar to ibuprofen). And this treatment always works. Well, mostly.

Although hemicrania continua always responds to indomethacin, dosages may vary and its effectiveness may change over time.

But there’s a worse problem – side effects. Stomach problems, ringing in the ears – and even more headaches, to name a few of the more common issues.

So although patients are encouraged to periodically try to lower the dosage (once they’re stabalized), the possibility of new treatments is very attractive.

Melatonin is one of the main alternative treatments for hemicrania continua. There are few other treatments, and even melatonin has been studied very little. This is mainly because this is such a rare disorder.

However, more and more patients are trying melatonin as a safer alternative to indomethacin. Some patients start taking melatonin and are able to phase out indomethacin use. The melatonin may be taken during the day (it’s usually taken before bed as a sleeping aid).

Researchers at the University College London Medical School are encouraging doctors to take this treatment more seriously, after describing the case of another patient who found relief with melatonin.

Melatonin is inexpensive and widely available. Although it’s considered generally safe, do talk to your doctor if you plan to take it for more than a few days.

22 July 2013

Hemicrania Continua Facts

James Information 2

A rare, constant, one-sided, moderate to severe headache.
It goes on for 3 months and more!

Fact: The headache is always on the same side.

Accompanied by at least one of these symptoms:

Congestion
Pupil constriction
Drooping eyelid
Watery eye
Red eye

Fact: More women than men have HC

Hemicrania continua is always treated with indomethacin under medical supervision.

For more information on hemicrania continua, check here:

Classification of hemicrania continua (more details on the above information)
Hemicrania Continua Fact Sheet (Migraine Trust)
More information, current research and trials (National Institute of Neurological Disorders and Stroke)

2 May 2009

Popular ways to misdiagnose Hemicrania Continua

James Discoveries & Stats, Medications 69

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.

Popular Misdiagnosis

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.

19 April 2005

Headache almost every day? What kind?

James Misc 0

Two types of headache that are similar, but usually should be treated differently: Transformed migraine and Chronic tension-type headache. The second type happens to many people from time to time. Every day or every other day you find yourself with a tension headache. It’s usually on both sides of the head and has that pressing pain. It doesn’t get worse with activity, and you’re usually not sick to your stomach – it’s just there. Still there.

Transformed migraine is now often called chronic migraine. It occurs in patients that have a history of migraine. Over the years, attacks become more frequent, until they end up with something similar to chronic tension-type headache. They may or may not have migraine attacks like they used to – just this daily or near daily background headache. If this is you, you probably actually are getting mild migraine attacks, not tension headache at all.

The causes of these headaches are different with everyone, but it’s important to know which you have in order to be treated. Generally, you won’t be "cured" of your headaches, but they can be very much reduced. In the case of transformed migraine, many sufferers have a form of rebound headache. This means that painkiller use can be tapered off and the headaches can taper off as well. But there can be other causes as well, such as a virus or a drug you’re taking or food you’re eating.

Other types of chronic headache include Hemicrania continua (a one sided headache usually treated with Indomethacin) and new daily persistent headache(typically in patients with no history of headache).

Both these headaches are of the kind that you need to see a doctor about. Make sure she knows your medical history so that an accurate diagnosis can be made.