Hemicrania Continua

Medically Reviewed by Zilpah Sheikh, MD on August 26, 2024
Written by Brenda Goodman, MA, Shawna Seed
5 min read

Hemicrania continua is a headache disorder that causes constant pain on one side of your head and face. The level of pain may go up and down, but it almost never goes away. The pain always affects the same side of your head.

This type of headache can affect anyone. But women and those assigned female at birth are more likely to get it, and it's more common among adults.

Hemicrania continua causes many of the same symptoms as migraine episodes, but it's a different type of headache. Migraine symptoms come and go.

With the right treatment, most people can get nearly complete relief from the pain.

People with hemicrania continua describe a dull ache or throb, often interrupted by pain that is:

  • Jolting
  • Sharp
  • Stabbing

These intense episodes usually happen three to five times a day.

 

Some people will have these headaches steadily for months or years. Others may have pain that lasts at least 3 months, then goes away for weeks or months, and then comes back.

The headaches often have some of the same symptoms as other kinds of headaches. This overlap can make them tricky for doctors to diagnose.

Like migraine episodes, they can cause:

  • Nausea or vomiting
  • Sensitivity to noise or light
  • Throbbing pain

Hemicrania continua also shares features of cluster headaches. For example, people who have it may have problems with how part of their nervous system works. That causes symptoms that happen on the painful side of the face and head, including:

  • Stuffy or runny nose
  • Nosebleeds (which are rare)
  • Tearing, redness, or irritation of the eyes
  • Drooping eyelids
  • Sweating

Some things tend to make symptoms worse, such as:

  • Stress
  • Changes in sleep patterns
  • Bright lights
  • Fatigue
  • Overdoing exercise
  • Alcohol

Experts don't know what causes hemicrania continua. It doesn't appear to be triggered by outside factors such as stress or poor sleep, but those things can worsen the pain.

Some people have symptoms when they:

  • Feel pressure on their neck
  • Flex or rotate their neck

 

If you have hemicrania continua, it may take some time to get the correct diagnosis.

Keeping a headache diary and recording your symptoms over a period can be helpful. Your doctor may ask you to keep track of: 

  • Where your head hurts
  • When the pain gets worse
  • How long the stretches of intense pain last
  • Any other symptoms, such as nausea or a runny nose

Your doctor might order imaging tests, such as a CT scan or MRI, to check your brain. This can help rule out other possible causes of your symptoms.

One of the methods doctors use to diagnose hemicrania continua is to give you a medicine known to be effective against it. If your symptoms go away, that's important evidence that you have hemicrania continua.

For an official diagnosis of hemicrania continua, you must have

  • A headache on one side of your head that happens daily or never lets up. You'll sometimes have bursts of intense pain. 
  • Pain that has lasted for more than 3 months
  • Pain that affects the same side of your head and never shifts to the other side

You'll also have at least one of these symptoms:

  • Your eyes are red or tearing up
  • You're congested, have a runny nose, or both
  • Your eyelid droops (ptosis)
  • The pupil of your eye is noticeably smaller (miosis)

Some anti-inflammatory medications ease hemicrania continua headaches. Indomethacin (Indocin, Tivorbex), a nonsteroidal anti-inflammatory drug (NSAID), often gives fast relief. One way doctors know that you have hemicrania continua is if your headaches go away after a dose of the drug.

Daily doses of indomethacin for hemicrania continua typically range from 25 to 300 milligrams. Your doctor may start you on a low dose taken three times a day with meals. It may take some time to find the correct dose.

A common side effect of the drug is irritation of the linings of the stomach and digestive tract. People who take it may also need medication to help their stomach make less acid. Because of the side effects, your doctor will try to find the lowest effective dose for you.

If the side effects of indomethacin are too much for you, you may be prescribed another NSAID, celecoxib.

Tricyclic antidepressants, such as amitriptyline, also might prevent these headaches.

A new, nondrug treatment is available as well. It uses a handheld device to stimulate your vagus nerve with an electric current. This type of treatment is called noninvasive vagal nerve stimulation. GammaCore is one device marketed for this type of treatment. You hold the device against a spot on your neck for 2 minutes to ease pain.

Experts are still investigating how well nerve stimulation works for hemicrania continua. Because it's such a rare disorder, it's hard for researchers to conduct large studies. However, the treatment has shown promise in the research done so far.

Hemicrania continua is a headache disorder. When you have it, one side of your head hurts almost all the time, with occasional spikes of more intense pain. It can be difficult to diagnose because some symptoms are similar to those of migraine episodes and other conditions. One way your health care provider can tell if you have hemicrania continua is to give you an anti-inflammatory drug that's effective against it. If your pain eases, that's a sign that you have this rare headache disorder.

Does hemicrania continua go away?

Some people do have just one episode of hemicrania continua pain. But it's possible that it will flare up occasionally for the rest of your life. Medication can keep the pain under control.

What triggers hemicrania continua?

Experts don't know the exact cause of this condition or what triggers its episodes. There's some evidence that vigorous exercise or drinking alcohol can make the pain worse.

What is the age of onset for hemicrania continua? 

Adults are most likely to have this condition, and it's more common among women and those assigned female at birth.