August 24, 2015: Hemicrania continua

Interested in submitting an E-Pearl?
Brought to you by the Residents & Fellows Section of Neurology.

August 24, 2015

Hemicrania continua

First recognized in 1984, hemicrania continua is a type of primary headache disorder characterized by unremitting, unilateral head pain that resolves with indomethacin. While it has an unknown prevalence and is considered rare, hemicrania continua has been the subject of over 100 case reports since the 1980s. The mean age of onset is in the fourth decade, and it affects women slightly more frequently than men. To-date, no clear hereditary pattern has been established.

The International Headache Society diagnostic criteria states that the headache duration must be at least three months, strictly unilateral and without contralateral shift, every day, continuous, and moderate in intensity with intermittent severe exacerbation periods. Hemicrania continua must also demonstrate at least one ipsilateral autonomic feature such as conjunctival injection, lacrimation, rhinorrhea, facial sweating, eyelid edema, ptosis or miosis. The headache must completely resolve with appropriately-dosed indomethacin, and other aspects of the patient's history and exam cannot be suggestive of alternative head pain disorders such as migraine with aura, cluster headache, or trigeminal neuralgia.


  1. Primary Headaches - Hemicrania Continua. In: IHS Classification ICHD-II [online]. Available at Accessed February 2015.
  2. Cittadin E, Goadsby P. Update on hemicrania continua. Curr Pain Headache Rep 2011; 15: 51–56.
  3. Moura LM, Bezerra JM, Fleming NR. Treatment of hemicrania continua: case series and literature review. Rev Bras Anestesiol. 2012; 62: 173-187.

Submitted by Sarah Wesley MD, Department of Neurology, Mount Sinai Beth Israel Medical Center.

Disclosures: Dr. Wesley is a member of the Residents & Fellows Section of Neurology

For more clinical pearls and other articles of interest to neurology trainees, visit Neurology. Listen to this week's Neurology Podcast.


Forgot password?