Symptoms, Prevalence, and Diagnosis
In addition to chronic pain, symptoms of the disorder include runny nose, tearing and redness of the eyes, sweating, drooping eyelids, nausea, vomiting, and sensitivity to light. It is unknown how prevalent hemicrania continua headaches are among the public. Chronic headaches, the larger classification, affect 4 to 5% of the general population. Other chronic headache sub-types include transformed migraine, chronic tension-type headache, and daily persistent headache. Among those who suffer from chronic headaches, a 5-year study of 651 headache sufferers found that 2.2% of these study participants experienced hemicrania continua headache pain. Researchers have found that hemicrania continua headaches, like migraine headaches, are more common among women. In addition, research indicates that exercise and alcohol consumption can worsen hemicrania continua headache symptoms.
Treatment
The most commonly prescribed treatment for hemicrania continua is indomethacin, an anti-inflammatory oral medication. Hemicrania continua headaches are referred to as indomethacin responsive, meaning in most cases the symptoms are eliminated after several doses of the drug. However, as with other anti-inflammatory medications, the side effects of indomethacin often preclude long-term usage. In fact, 25% to 50% of patients on indomethacin therapy eventually develop the gastrointestinal side effects commonly caused by this medication, including abdominal pain, stomach ulcers, and intestinal bleeding. Other side effects may include excessive fatigue, unexplained bruising or bleeding, blurred vision, ringing in the ears, and chronic constipation.
Other Treatment Options
Although no medication has been proven to treat hemicrania continua headaches as effectively as indomethacin, new research has uncovered other treatment options. Among those most commonly use alternative therapies include cyclooxygenase-2 inhibitors, gabapentin, melatonin, topiramate, verapamil, onabotulinumtoxinA, occipital nerve stimulation, and vagus nerve stimulation. Several case studies have demonstrated that the herbal supplement melatonin could be a promising alternative therapy. Available over-the-counter, melatonin has a chemical structure similar to indomethacin, but it is found naturally in the body. One case study indicated a 7-mg supplement at bedtime completely relieved symptoms for this individual. However, the herbal supplement is not subject to approval by the FDA and, as with any medical condition, patients should consult their healthcare provider before beginning any therapy. According to the National Institutes of Health, side effects may include dizziness, mood changes, increased risk of seizure, decreased sperm count among men, decrease in blood pressure, and increased blood sugar levels.
Researchers have also found the prescription drug topiramate to be a promising treatment. Topiramate is an anticonvulsant medication that reduces irregular brain activity. Although several small case studies have found the medicine beneficial, larger studies are needed to learn whether the benefits of the drug outweigh the potential side effects, which include dizziness, inability to concentrate, confusion, increased risk of kidney stones, and increased risk of osteoporosis. In addition, topiramate can cause difficulty for a person to sweat. As with any medication regiment, care should be taken to follow your healthcare provider’s orders. Missing doses can lead to a “rebound effect.” This refers to a resurgence of headache symptoms as soon as the medication is out of the bloodstream. If the side effects of a medication become troublesome, patients should consult with their healthcare provider before stopping treatment.
