Continuous hemicrania responsive to early testing with indomethacin: case report

Abstract

Introduction
Hemicrania continua (HC) is a primary headache characterized by persistent unilateral pain of moderate intensity, associated with autonomic signs and responsive to indomethacin. Early diagnosis is important because it is a highly disabling condition, and appropriate and immediate treatment can lead to symptom remission.
Case Report
A 63-year-old woman presented with a 5-day history of intense and continuous left temporal headache without remission, associated with conjunctival hyperemia, tearing, and semiptosis. Pain intensity was rated 9/10, with no response to common analgesics. Neurological examination confirmed ipsilateral autonomic signs, without other focal deficits. Brain MRI with contrast showed no abnormalities. Although she did not meet the minimum duration criterion for HC, early treatment with indomethacin (50 mg twice daily) was initiated, resulting in significant clinical improvement within six days, with remission of pain and autonomic signs. 
Discussion
The diagnosis of hemicrania continua is based on continuous unilateral headache, presence of ipsilateral autonomic symptoms, and complete response to indomethacin. However, many patients may not meet the duration criterion at initial presentation. 
Conclusion
Early therapeutic evaluation with indomethacin should be considered in patients presenting with continuous unilateral headache and autonomic symptoms suggestive of hemicrania continua, even when the minimum duration criterion has not yet been reached. Early diagnosis may significantly reduce disease impact and improve clinical outcomes.