Sometimes we have headaches, right? We don't know where the pain went when we took a pill or slept for a while. But imagine that the same side of your head hurts non-stop... not for a day or two, but for months. Sometimes the pain becomes unbearable. This is the nature of the special headache we are going to talk about today called Hemicrania Continua. Although this is a name that you may not be used to hearing, there are people in our society who suffer from this condition. Therefore, being aware of this can be very important for you and your loved ones.
Simply put, what is Hemicrania Continua?
This name may sound a bit complicated, but its meaning is very simple. It is made up of two Latin words. "Hemicrania" means "half of the head." "Continua" means "continuous." So, simply put, it is "pain that continues on one side of the head."
Doctors call this a primary headache disorder . This means that there is no underlying medical condition (such as a brain tumor or infection) causing the headache. It is a condition that starts as a headache. So it is nothing to be afraid of, but it is very important to identify it and get it treated properly.
There are two main types of this.
Hemicrania Continua headaches can come in two main forms.
- Chronic type: In this type, you have headaches all the time, constantly. The pain is constant and there is no relief.
- Remitting type: In this type, headaches occur daily for about six months, then go weeks or months without any pain. The headaches start again. It seems to come and go.
What are the symptoms of this headache?
There are several specific characteristics that can distinguish this headache from other common headaches. I will put them in a table like this to make them easier to understand.
| The nature of the characteristic | Description |
|---|---|
| Main symptoms | |
| Pain on one side | The pain always occurs on the same side of the head and face. If it's on the right side, it's always on the right, and if it's on the left side, it's always on the left. The side doesn't switch. |
| Constant pain | This pain should last for at least three months. It is always felt as a mild, dull ache. |
| Severe pain attacks | On top of that constant dull ache, there's a sharp, stabbing pain three to five times a day. This can last for a few minutes or a few hours. |
| Additional symptoms that accompany the headache (these also occur on the same side as the pain) | |
| Eye-related symptoms | - Redness of the eye on the side of pain. - Tears are flowing from that eye. - Drooping eyelid (Ptosis). - Difficulty looking at light (photophobia). |
| Nose-related symptoms | - Nasal congestion on the side of pain. - Runny nose on that side. |
| Other features | - Nausea and vomiting. - Difficulty hearing loud noises. |
What are the situations where the pain may increase?
If you have Hemicrania Continua, certain things can cause your migraines to suddenly become more severe. The two main things are:
- Drinking alcohol
- Engaging in strenuous physical activities
Think about it, other types of headaches often get worse when stress increases, or when you don't get enough sleep, right? But surprisingly, these things don't have much effect on Hemicrania Continua headaches. This is an important point that helps in diagnosing this type of headache.
Why does this kind of headache occur?
Doctors still don't know exactly what causes these headaches, but research suggests a few things.
- Inflammation of the cavernous sinus: This is a space inside our brain that protects important blood vessels, nerves, and things like the pituitary gland. It is thought that inflammation in this area may be the cause.
- Widened arteries: Widening of the blood vessels that supply blood to the brain can lead to nerve compression.
- A problem with the functioning of the trigeminal nerve: This is the main nerve that carries sensations from our face to the brain. It is suspected that this pain may be caused by some malfunction in its function.
Although this condition can occur in anyone, it is more common among women .
How does the doctor diagnose this?
When you go to see a doctor with these symptoms, the first thing he or she will do is examine you carefully and ask you about your symptoms. He or she will ask you questions like where it hurts, how long it has been there, what the pain feels like, and how often the pain is severe.
Your doctor may ask you to keep a headache diary to help you. It is very important. Write down the following things in it:
- The day and time the headache occurred.
- Exactly where it hurts in the head.
- I wonder if the pain increased after doing something.
- How long did the severe pain last?
- Are there any other symptoms such as nausea or watery eyes along with the headache?
With this information, your doctor can get a better idea of your condition. In addition, they may order a CT scan (computed tomography scan) or MRI scan (magnetic resonance imaging scan) to make sure there are no other problems with your brain.
What is the best treatment for Hemicrania Continua?
The best thing about this headache is that it has a very effective treatment. The main and most effective medication for this is Indomethacin .
Indomethacin is a drug in a class of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). It works by reducing inflammation and pain in the body.
Usually, the doctor will tell you to take this medicine in a low dose three times a day. It is very important to take this medicine with food . Otherwise, things like stomach upset can happen. Surprisingly, within a day or two of starting this medicine, most people's pain is almost completely gone. You can definitely expect good results within a week.
Once your headache is completely gone, your doctor will gradually reduce the dose of your medication. His goal is to give you the lowest dose that will control your symptoms.
Let's also be aware of the side effects of Indomethacin.
Like all medications, this one can have minor side effects, but not everyone gets them.
| Side effects of Indomethacin | |
|---|---|
| Commonly seen side effects | |
| Constipation | Diarrhea |
| Dizziness | Ringing in ears |
| Vomiting | |
| Serious side effects that should be taken into account and reported to the doctor immediately | |
| Increased heart rate | Back pain |
| Difficulty breathing (dyspnea) | Fever |
| Pain when urinating (dysuria) | Skin rash , itching, blistering |
| Severe stomach pain | Body swelling |
| Vision changes | |
Are there other options if Indomethacin doesn't work?
Indomethacin can often control this condition. However, some people may not be able to take it due to side effects. If so, your doctor may recommend other medications.
- Amitriptyline
- Corticosteroids
- COX-2 inhibitors (e.g. celecoxib)
- Gabapentin
- Melatonin
- Topiramate
- Naproxen
In addition to these medications, in some cases, the doctor may also consider other treatments, such as botulinum toxin-A injections and vagus nerve stimulation.
Is this situation dangerous? What is the outlook?
This is the most important thing. Hemicrania Continua is not a dangerous or life-threatening condition. Also, it is not a symptom of any other serious illness. So don't be afraid of it.
However, only those who have experienced this type of constant pain know how difficult it is to live with. It can be difficult to carry out your daily tasks and think clearly. Being in constant pain can also affect your mental health.
Living with this constant pain can be a very frustrating experience. You may not feel like getting out of bed, going to work, or laughing and chatting with friends. Even doing simple tasks can feel like you have to work twice as hard when you're in pain.
But the good news is that this is a very treatable condition . By working with your doctor to find the right treatment and dosage for you, you can get back to your normal life without any interruptions.
Take-Home Message
- Hemicrania Continua is a persistent, throbbing pain on one side of the head. It can be accompanied by severe attacks .
- Symptoms such as redness of the eye on the side of the pain, tearing, and nasal congestion are also commonly seen with this.
- This condition is not life-threatening, nor is it a symptom of another serious illness.
- The main and most effective treatment for this is the drug Indomethacin.
- If you have a persistent headache like this, please do not ignore it and consult a qualified physician, or your "doctor." With proper diagnosis and treatment, you can make a full recovery.
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