Hemicrania Continua – The Continuous Headache

Hemicrania continua is a relatively rare type of chronic daily headache. The pain occurs on one side of the head and varies in intensity without ever disappearing completely. The pain is usually moderate, but may include jolts of severe pain that last less than a minute. The flare-ups of severe pain may be accompanied by tearing or redness of the eye on the affected side, swelling or drooping of the eyelid, and a stuffy or runny nose. You may experience nausea, vomiting, and sensitivity to noise and light. Sometimes auras such as blind spots or flashing lights in your visual field or sensations of numbness or tingling are present as well.

The cause of a chronic daily headache is not well understood. For primary chronic daily headaches, possible factors may include:

• Medication overuse (Tylenol, opioids)
• Muscle tension or tissue inflammation
• Abnormal function of brain structures that suppress pain
• Changes in the nervous system due to frequent headaches
• Stimulation of the central nervous system due to stress, infection, or trauma
• Injury of the upper spine
• Vasculitis
• Tumors
• Infection
• Obstructive sleep apnea

Chronic daily headaches are more common in women than in men. Various factors may increase the chance of having headaches, including:

• Anxiety
• Depression
• Sleep disturbances
• Obesity
• Snoring
• Overuse of caffeine
• Overuse of pain medication

When a headache occurs three or more times a month, preventive treatment is usually recommended. Drug therapy, biofeedback training, stress reduction, and elimination of certain foods from the diet are the most common methods of preventing and controlling migraine and other vascular headaches. Regular exercise, such as swimming or vigorous walking, can also reduce the frequency and severity of migraine headaches. Drug therapy for migraine is often combined with biofeedback and relaxation training. One of the most commonly used drugs for the relief of migraine symptoms is sumatriptan. Other drugs used to prevent migraine include methysergide maleate, which counteracts blood vessel constriction; propranolol hydrochloride, which also reduces the frequency and severity of migraine headaches; ergotamine tartrate, a vasoconstrictor that helps counteract the painful dilation stage of the headache; amitriptyline, an antidepressant; valproic acid, an anticonvulsant; and verapamil, a calcium channel blocker. Another antidepressant such as the selective serotonin reuptake inhibitor (SSRI) fluoxetine, commonly known as Prozac, may occasionally be an effective alternative for some people. Muscle relaxants such as tizanidine, or Zanaflex, may help some people manage chronic daily headaches.

Injections may be of benefit in certain conditions. Trigger point injections in tender muscles, nerve blocks (trigeminal, facial, supraorbital), or epidural steroid injections have been used effectively. Severe cases can be managed as in-patients in multidisciplinary clinics.

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