Persistent One-Sided Headache: Symptoms, Causes, Treatment Options, and Beyond
Hemicrania continua is a primary headache disorder that causes continuous pain on one side of the head for prolonged periods. This condition can be divided into two types: chronic and remitting.
Symptoms and Diagnosis
The most common symptom of hemicrania continua is a dull, continuous headache on one side of the head that lasts for days or weeks. Other symptoms may include occasional throbbing pain, eye redness or tearing, miosis (contracture of the iris), nasal congestion, ptosis (drooping eyelid), runny nose, and restlessness or pain aggravated by movement. At least one additional symptom, including runny nose, ptosis, nasal congestion, restlessness, miosis, or redness or tearing in the eye, is required for a diagnosis.
To be diagnosed with hemicrania continua, a person must have ongoing, dull headache for 3 or more months, and the headache must get better with therapeutic doses of indomethacin. The International Headache Society provides clear criteria for diagnosing hemicrania continua.
Treatment Options
The most effective treatment for hemicrania continua is indomethacin, a type of nonsteroidal anti-inflammatory drug (NSAID). However, not everyone can tolerate taking indomethacin, and for mild side effects, acid-suppression medicine may be prescribed. If a person experiences side effects from taking indomethacin, they should talk with their doctor about other possible treatment options that may be effective in preventing headache pain.
A doctor may also prescribe celecoxib, another form of NSAID, or amitriptyline, a tricyclic antidepressant, to help prevent headache pain.
Prevention and Management
If a person has a dull and one-sided headache, they should keep a headache journal and contact their doctor when they reach or approach the 3-month mark. Continuing the headache journal after receiving a diagnosis of hemicrania continua can help determine if their treatment regimen is working.
Beyond alcohol consumption and physical exertion, known risk factors and triggers for hemicrania continua include female sex (with a female-to-male ratio around 2.4:1) and potentially regional or environmental factors, though specifics beyond these are less well defined in the literature. Stress and possibly allergic or sinus-related factors may also contribute to symptom exacerbation in hemicrania continua, but direct causal links specific to this condition are not well characterized.
It is essential to remember that hemicrania continua has no cure, but a person can prevent pain from returning through continual preventative medication use. If a person experiences a severe headache accompanied by fever or other concerning symptoms, they should seek immediate medical attention, as it could be a symptom of a more serious health condition.
[1] Migraine Research Foundation. (2021). Hemicrania Continua. [online] Available at: https://migraineresearchfoundation.org/resource/hemicrania-continua/
[4] Mayo Clinic. (2021). Hemicrania Continua. [online] Available at: https://www.mayoclinic.org/diseases-conditions/hemicrania-continua/symptoms-causes/syc-20356631
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