Hemicrania Continua (Continuous Headache): Symptoms and Treatment

If you’ve ever had a headache that just would not quit, you probably thought,
“This can’t be normal.” For some people, that’s exactly true. A rare condition
called hemicrania continua causes a continuous headache on one
side of the head that can last for months or years. The pain may ease or flare,
but it never fully goes away without treatment. And no, unfortunately, “more coffee”
is not the cure.

In this guide, we’ll break down what hemicrania continua is, how it feels, how it’s
diagnosed, and which treatments (especially indomethacin) can help. We’ll
also look at real-life experiences and practical tips for living with this rare but
very real condition. This article is for education only and is not a substitute for
personal medical advicealways talk with a healthcare professional about your own
symptoms.

What Is Hemicrania Continua?

Hemicrania continua (HC) is a primary headache disorder, meaning it’s
not caused by another condition like a brain tumor or infection. The name literally
means “pain in half the head,” and that’s exactly what it does: it causes a
continuous, one-sided headache that lasts at least three months and
does not switch sides.

HC belongs to a small group of headache conditions called
trigeminal autonomic cephalalgias (TACs), which also includes cluster
headache and paroxysmal hemicrania. TACs are known for severe, one-sided pain plus
cranial autonomic symptomsthings like a red, tearing eye or a runny nose on
the same side as the headache.

One thing that makes hemicrania continua stand out is its dramatic response to
the anti-inflammatory drug indomethacin. When the dose is correct,
the headache typically disappears completely. This “indomethacin responsiveness”
is such a defining feature that it’s built into the official diagnostic criteria.

Key Symptoms of Hemicrania Continua

Core Headache Features

According to international headache criteria and clinical reviews, HC usually has:

• Strictly one-sided head pain (unilateral), always on the same side
• Continuous headache for at least 3 months – there are no completely
  pain-free days
• Baseline mild to moderate pain that’s always present, often described
  as dull, pressure-like, or aching
• Exacerbations or flares of more intense, stabbing, or throbbing pain
  superimposed on the constant ache

People often report several flares per day, although the pattern can vary. During these
flares, the pain can become severe enough to stop normal activities and make focusing
almost impossible.

Cranial Autonomic and Migraine-Like Symptoms

HC isn’t just “a bad one-sided headache.” Many people experience symptoms on the same
side as the pain, such as:

• Red or watery eye
• Nasal congestion or a runny nose
• Drooping or puffy eyelid
• Facial sweating or flushing
• Smaller pupil (miosis) or slight eyelid droop (ptosis)

On top of that, HC can also look a little like migraine. Nausea, sensitivity to light
(photophobia), and sensitivity to sound (phonophobia) are common, and they may be more
intense during flares. Some people also feel restless or agitated during severe attacks.

While most cases involve strictly one-sided pain, a small percentage of people may
experience bilateral pain (on both sides of the head), which can confuse the diagnosis.

How Hemicrania Continua Feels Day to Day

Many people describe HC as “a shadow of pain that never leaves.” Even on “better” days,
there’s still a noticeable ache. On bad days, the flares can feel like someone is
tightening a clamp on one side of the skull or stabbing behind the eye repeatedly.

Sleep might bring some partial relief, but the headache is there when they wake up.
Over time, this can affect mood, energy levels, work, and relationshipsespecially
before the correct diagnosis is made.

How Is Hemicrania Continua Different from Migraine or Cluster Headache?

HC is often misdiagnosed as chronic migraine, tension-type headache, or even sinus
headaches. Studies suggest that people may go yearssometimes around eight years on
averagebefore receiving an accurate diagnosis.

Here’s how HC typically differs from other headache disorders:

• Versus migraine: Migraine attacks come in episodes that last hours
  to a couple of days, with pain-free periods between them. HC is continuous
  for months or longer. Migraine doesn’t have the same strict indomethacin response.
• Versus cluster headache: Cluster headache causes excruciating,
  short-lasting attacks (15–180 minutes) with symptom-free gaps. HC has continuous
  background pain plus flares, and responds completely to indomethacin, whereas
  cluster headache usually does not.
• Versus paroxysmal hemicrania: Paroxysmal hemicrania causes many
  short attacks per day, but without continuous background pain. Both are usually
  indomethacin-responsive, but the pattern of pain is different.

What Causes Hemicrania Continua?

The exact cause of hemicrania continua is still unknown. Like other trigeminal autonomic
cephalalgias, it’s believed to involve:

• The trigeminal nerve, which carries pain signals from the face
• The autonomic nervous system, controlling tear production, nasal
  secretions, and blood flow
• Deep brain structures such as the hypothalamus, which help regulate rhythms and pain

Imaging and research suggest abnormal activation in these regions, but no simple blood
test or scan can “prove” HC. That’s why diagnosis is based mainly on clinical criteria
and the response to indomethacin.

HC is considered a primary headache, so it’s not usually caused by an
underlying structural problem. However, very rarely, HC-like headaches can be
“secondary” to another condition (for example, certain brain lesions). This is one
reason why doctors often order brain imaging (like MRI) when symptoms suggest HC.

How Hemicrania Continua Is Diagnosed

The official criteria from the International Classification of Headache Disorders (ICHD-3)
include several key points:

• Unilateral headache present for > 3 months
• Continuous pain with periods of moderate to severe intensity (flares) without
  complete remission
• At least one cranial autonomic symptom (such as tearing, nasal congestion,
  eyelid swelling) on the same side
• Complete response to indomethacin at therapeutic doses, in the
  absence of other explanations

A neurologist or headache specialist will typically:

• Take a detailed history of your symptoms and headache pattern
• Perform a neurological exam
• Order imaging (usually MRI) to rule out other causes, especially if symptoms are
  new, changing, or atypical
• Conduct an indomethacin trial, gradually increasing the dose while
  monitoring for response and side effects

If the headache disappears completely on the right dose of indomethacin and then
returns when the drug is stopped, that strongly supports the diagnosis of HC.

Treatment Options for Hemicrania Continua

Indomethacin: The Gold-Standard Treatment

Indomethacin is a nonsteroidal anti-inflammatory drug (NSAID), but in HC it behaves
like a “magic switch.” When it works (and in HC it almost always does), the continuous
headache and flares can disappear completely. This nearly complete response is so
characteristic that some experts call HC an “indomethacin-responsive headache
disorder.”

Typical treatment involves:

• Starting at a low dose and slowly increasing under medical supervision
• Using the lowest effective dose that keeps the headache away
• Taking the medication with food and often adding a proton pump inhibitor
  (PPI) or other stomach-protective drug, because indomethacin can irritate the stomach
  and increase the risk of ulcers or bleeding

Indomethacin isn’t right for everyonefor example, people with certain kidney problems,
a history of major gastrointestinal bleeding, or specific cardiovascular risks may need
alternatives. That’s why it must be prescribed and monitored by a healthcare professional.

When You Can’t Take Indomethacin: Other Options

Some people can’t tolerate indomethacin or can’t stay on it long term. In these cases,
doctors may try other medications, often based on smaller studies and case reports, such as:

• Topiramate (an anti-seizure and migraine-preventive drug)
• Gabapentin or similar nerve-pain medications
• Melatonin at higher, prescription-style doses
• Verapamil (a calcium channel blocker used in some TACs)
• OnabotulinumtoxinA (Botox) injections in some resistant cases
• Occipital nerve blocks or nerve stimulation for severe, refractory
  HC when medications fail

While these options don’t have the same strong evidence as indomethacin, they can
provide meaningful relief for people who can’t use the “classic” treatment.

Lifestyle Strategies and Self-Care

Lifestyle changes will not cure hemicrania continua, but they can make living with a
chronic headache easier and reduce overall pain burden:

• Keep a headache diary. Track pain intensity, triggers, sleep,
  medications, and flares. This helps you and your doctor see patterns and measure
  treatment response.
• Prioritize sleep. Aim for a consistent sleep scheduletoo little OR
  too much sleep can worsen head pain in many disorders.
• Manage stress. Techniques like mindfulness, breathing exercises,
  yoga, or gentle stretching can reduce muscle tension and emotional distress.
• Limit medication overuse. Overusing pain relievers may lead to
  medication-overuse headache on top of HC, making everything worse.
• Stay active when you can. Light to moderate exercise (with your
  doctor’s approval) can support mood and overall health.

It can also be helpful to bring a partner, friend, or family member to important
appointments so they can better understand your condition and support you.

When to Seek Medical or Emergency Care

You should seek prompt medical evaluation if you develop:

• New, persistent one-sided headache that doesn’t go away
• Headache with vision changes, weakness, confusion, or difficulty speaking
• “Thunderclap” headache that peaks in seconds
• Headache with fever, neck stiffness, or recent head injury

These can sometimes signal serious conditions that need emergency care. Even if you’ve
had migraines for years, a new patterna continuous one-sided headache that never fully
resolvesdeserves medical attention and possibly evaluation by a headache specialist.

Living with Hemicrania Continua: Real-Life Experiences

Let’s be honest: having a headache that literally never clocked out would test the
patience of a saint. Many people with hemicrania continua describe a long, frustrating
journey before getting the right diagnosis.

The Long Road to a Name

One common experience is the “migraine merry-go-round.” Someone develops a one-sided
headache in their 20s or 30s. At first, it’s brushed off as stress or sinus pressure.
Over time, it becomes obvious something is wrong: the pain never completely goes away.
Doctors often start with the usual suspectsmigraine, tension-type headache, sinusitisand
try standard migraine medications or nasal sprays.

The problem? These treatments might help a bit but rarely give complete relief. The
patient ends up juggling multiple meds, rescue treatments, and lifestyle changes while
still living with a daily headache. It’s only when someone notices the key pattern
strictly one-sided, always present, with flares and autonomic symptomsthat
HC enters the conversation.

For many, the indomethacin trial is a turning point. People sometimes describe it like
“someone finally turned off the background noise in my head.” That momentwaking up
without the constant ache for the first time in months or yearscan be both emotional
and life-changing. Of course, it also comes with the realization: “So this was HC all
along.”

Navigating Work, Family, and Daily Life

Hemicrania continua doesn’t politely schedule itself outside working hours. It shows up
at the morning staff meeting, through your commute, during your kid’s school play, and
while you’re lying awake at 3 a.m. wondering if you’ll ever feel “normal” again.

People with HC often become masters of quiet adaptation:

• Planning the day around predictable flaressaving mentally demanding tasks for times
  when pain is “only” at baseline
• Using simple tools like sunglasses, noise-canceling headphones, ice packs, or heating
  pads to take the edge off
• Leaning on flexible work arrangements where possible, such as remote work or adjusted
  hours

Emotionally, living with a constant headache can lead to anxiety or low mood. Some people
worry that others won’t believe them because they “look fine.” That’s why supportfrom
family, friends, online headache communities, or mental health professionalscan be so
important.

Finding a Care Team That “Gets It”

Another recurring theme in HC stories is the importance of a knowledgeable care team.
Many people finally get answers after seeing a headache specialist who recognizes HC’s
pattern and is familiar with indomethacin-responsive headaches.

A good care team will:

• Take your symptoms seriously, even if your scans are normal
• Explain why HC is different from more common headaches
• Walk you through the pros and cons of indomethacin and alternatives
• Help you manage side effects and adjust doses over time
• Coordinate care with your primary provider, eye doctor, or mental health professional as needed

When patients feel heard and understood, it becomes easier to manage a chronic condition.
Even if the goal isn’t “perfectly pain-free forever,” reducing pain to a manageable level
and regaining control of daily life can make a huge difference.

Practical Takeaways for People Living with HC

If you’re navigating hemicrania continua, here are some practical tips:

• Document your journey. Headache diaries, medication logs, and
  written symptom histories help new doctors quickly understand what you’ve already tried.
• Ask specifically about HC and TACs. Not all providers think of rare
  headache syndromes right away. Asking, “Could this be hemicrania continua?” can open
  a useful conversation.
• Respect your limits. You don’t have to push through every flare.
  Building rest into your routine is not weakness; it’s strategy.
• Protect your mental health. Living with daily pain is hard. Counseling,
  support groups, or therapy can be as important as medications.
• Celebrate small wins. A lower baseline pain, fewer flares this week,
  a day when you enjoyed an activity without thinking about your head every five minutesthese are real victories.

Hemicrania continua may be rare, but you’re not alone. With the right diagnosis,
targeted treatment (especially indomethacin when appropriate), and a supportive care
team, many people find significant relief and get their lives back on track.