Hemicrania Continua – The Challenges of Diagnosis!

September 7, 2009 by dean · Leave a Comment 

One Sided Headache

A Constant One Sided Headache

Hemicrania continua is defined as a constant one sided (and always on the same side) headache of moderate intensity with exacerbations and which responds to Indomethacin. Other possible symptoms include redness of the eye, a watery or teary eye, a blocked or runny nostril and drooping of the eyelid.

But we have case reports which show that this supposedly one sided (always the same side) headache can occur on the other side and can also be on both sides at the same time.

Interestingly the traditional classification system of headache and migraine states that Cervicogenic (neck-related) Headache as a one sided headache (and always the same side) also. However my experience of over 21000 hours with headache and migraine patients is that a one sided headache that can occur on the other side is a Cervicogenic Headache. Does this mean that I am saying Hemicrania Continua is likely to be Cervicogenic Headache – Yes!



(Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders, 2nd edn. Cephalalgia 2004; 24(suppl.1):1-151

Marano E, Giampiero V, Gennaro DR, di Stasio E, Bonusa S, Sorge F. ‘Hemicrania continua’: a possible case with alternating sides. Cephalalgia 1994; 14:307–8.

Matharu MS, Boes CJ, Goadsby PJ. Management of trigeminal autonomic cephalalgias and hemicrania continua. Drugs 2003; 63:1637–77.

Matharu MS, Bradbury P, Swash M. Hemicrania continua: side alternation and response to topiramate. Cephalalgia 2005; 26: 341-344

Newman LC, Lipton RB, Russell M, Solomon S. Hemicrania continua: attacks may alternate sides. Headache 1992; 32:237–8.

Newman LC, Spears RC, Lay CL. Hemicrania continua: a third case in which attacks alternate sides. Headache 2004; 44:821–3.

Sjaastad O, Fredricksen TA, Pfaffenrath V. Cervicogenic headache: diagnostic criteria. Headache 1998; 38:442-5)

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About dean
Consultant Headache & Migraine Physiotherapist; International Teacher; Director, The Headache Clinic & Watson Headache Institute; PhD Candidate Murdoch University, Western Australia; Adjunct Lecturer, Masters Program, Physiotherapy School, University of South Australia; MAppSc(Res) GradDipAdvManipTher Experienced health practitioners trained in the Watson Headache Approach perform the examination and treatment techniques developed by Dean Watson. These techniques are based on his extensive experience of 7000 headache patients (21,000 hours) over 21 years and are now taught internationally. For your nearest practitioner who has completed training in the ‘Watson Headache Approach’ please refer to the ‘Practitioner Directory’.

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