Ten new patients and 24 previous reports of hemicrania continua are reviewed from the Albert Einstein College of Medicine, and the Montefiore Medical Center, Bronx, NY. A 20-year-old man presented with an 8-year history of unilateral, right-sided headaches occurring in discrete bouts of continuous pain each lasting 6 months, approximately once yearly. The pain was constant and moderate in severity, with superimposed exacerbations of more severe pain, recurring two to three times daily, and associated with ipsilateral conjunctival injection, ptosis, lacrimation, and rhinorrhea. The patient would rock in a chair, pace, or hit his head against a wall in an effort to allay the pain. Treatments with carbamazepine, propanolol, verapamil, and lithium were of no benefit, whereas indomethacin 25 mg TID resulted in immediate and complete relief. Headaches recurred within 2 days on two occasions when treatment was discontinued during the 6-month pain cycle. Most patients were adults, but the onset was at 12 years of age in one and 18 years in one other. [1]

COMMENT. Hemicrania continua (HC) is distinguished from cluster headache by the continuous, moderate background pain, and when present, the relatively mild autonomic features. The authors described three types of HC: 1) a remitting or noncontinuous form (15%); 2) an unremitting form evolved from the remitting form (32%); and 3) an unremitting form with continuous headache lasting for years (53%). The majority (85%) have typically continuous, unremitting attacks. The diagnosis is important because of the remarkable response to indomethacin.