Hemicrania Continuum

This article originally appeared online at DrPullen.com.

I saw a patient a couple of weeks ago who had what sounded to me like trigeminal neuralgia, except that the severe one-sided head pains she was having lasted several minutes to an hour each episode, and recurred many times a day. The sharp, severe head pains of trigeminal neuralgia usually last only a second or two, maybe a few seconds, but not minutes to an hour. They can be really miserable, as they can come every few seconds in severe cases, but this just seemed like something different. I asked her to see a neurolgist as I’d never seen a patient with this type of pain, and when I got the consultation back the diagnosis was hemicrania continuum.

Hemicrania continuum is an uncommon head pain condition that seems midway between a cluster headache and trigeminal neuralgia. It has the lancing, sharp, almost electric shock type of pain described by patients with trigeminal neuralgia, but the pain lasts far longer, and is often assoicated with eye watering and nasal congestion on the affected side like cluster headaches.

Treatment of hemicrania continuum is usually with indomethacin, a tough-on-the-stomach anti-inflamatory medication, or sometimes with Celebrex, a newer COX-2 type anti-inflamatory medication.

It’s always good to feel like you learn something new in a day at the office. Too bad sometimes it is because a patient has a tough to treat, painful condition like this.

Ed Pullen, MD, is a board-certified family physician practicing in Puyallup, WA. He blogs at DrPullen.com — A Medical Bog for the Informed Patient.