Chronic and Hemicrania Continua Headaches
Chronic headaches are those occurring on a daily basis and affect about five percent of adults. They may be primary, where they gradually increase in frequency until they are occurring on a daily or near daily basis.
Alternately, they may be caused by an underlying disease or condition and thus classified as secondary. The consistent and repetitive nature of chronic headaches makes them particularly debilitating. They also account for the majority of referrals to headache specialists. By definition, a chronic headache occurs more than 15 days within a month.
What Are The Symptoms?Hemicrania continua is a rare type of chronic daily headache where the pain occurs on one side of the head. Although the pain will vary in intensity, it never completely disappears and tends to be mild to moderate with occasional periods of intense pain. As with migraine headaches, there are more females than males with hemicrania continua.
Hemicrania continua exists in two forms known as continuous and remitting. In the continuous form, headaches occur daily with little or no respite, often for years. In the remitting form, headaches may occur regularly over 1 to 6 months, separated by pain free periods of several weeks to months. Pain may occur as short jabbing jolts alongside the persistent daily headache.
Some of the symptoms include those similar to migraines, such as:
- Throbbing pain
- Nausea or vomiting
- Sensitivity to light
- Sensitivity to sound
Symptoms may also mimic those of cluster headaches and include:
- Tearing eyes and runny nose
- Drooping eyelid
- Redness on affected side
- Brief bouts of intense pain on one side
What Are the Causes and Risk Factors?There is typically no family history of headache in a patient with hemicrania continua. The precise causes and risk factors of hemicrania continua headaches are unknown but the following have been linked:
- Medication overuse
- Sleep Disorders
- Stimulants such as caffeine
Treatment OptionsA non-steroidal anti-inflammatory drug (NSAID) called indomethacin is commonly taken to provide rapid relief from symptoms. Unlike migraines, hemicrania continua headaches are usually quite responsive to indomethacin. In fact, hemicrania continua is particularly sensitive to indomethacin. Often, the diagnosis may not be clear until indomethacin is tried due to hemocrania continua's shared features of both migraine and cluster headache.
Indomethacin is generally well tolerated although gastrointestinal side effects might indicate a need for acid-suppression therapy. It should also be noted that there is a risk of kidney damage with indomethacin and this is something that you should discuss with your doctor. Other NSAIDs such as ibuprofen, celecoxib, and naproxen may be helpful. Amitriptyline and other tricyclic antidepressants are also effective in some patients and your doctor will likely discuss all medication options. It is also important to identify stressors in day-to-day life as reducing these may help in managing this form of chronic headaches.
Hemicrania continua is a relatively well-treated form of chronic headaches and most sufferers can find complete to near-complete relief by avoiding triggers and using medication daily.