Rigorously defined hemicrania continua presenting bilaterally

Background: Hemicrania continua (HC) represents a headache syndrome characterized by continuous, unilateral head pain, autonomic features, and a complete therapeutic response to indomethacin. While HC is classified as a unique entity among primary headache disorders, it clearly shares features with other primary headaches including trigeminal autonomic cephalalgias and chronic daily headaches, such as chronic migraine and chronic tension-type headache. Additionally, the diagnosis is often delayed secondary to a relatively low incidence and the occurrence of some phenotypic variability as found in previous case series.
Case: A 62 year-old woman presented with five months of unremitting, bilateral headache with significant autonomic symptoms during exacerbations of pain. Neurological exam and imaging studies were normal. After failure to respond to numerous prior therapeutic medicines and interventions, she experienced complete resolution following administration of indomethacin and eventual remission on sustained treatment.
Conclusion: This case demonstrates that hemicrania continua with requisite autonomic features can occur in a purely bilateral form. While the definitive aspects of HC continue to evolve, a bilateral headache meeting the current criteria warrants a therapeutic trial of indomethacin.

Southerland, Andrew M., and Ivan S. Login. "Rigorously defined hemicrania continua presenting bilaterally." Cephalalgia 31.14 (2011): 1490-1492. Available: ISSN:0333-1024, ["http://cep.sagepub.com/content/31/14/1490.long"].

This work has passed a peer-review process.