Hemicrania Continua
Hemicrania continua is a headache that stays on one side of the head and never fully goes away, with times when it gets much worse. It is rare, but it is treatable.
What is hemicrania continua?
Hemicrania continua is a primary headache disorder. That means the headache is the condition itself, not a symptom of another illness. It is less common than migraine, though experts think it may affect more people than once believed.
It belongs to a small group of headaches called trigeminal autonomic cephalalgias (TACs). These cause one-sided head pain together with “autonomic” symptoms, such as a watery eye or stuffy nose, on the same side. Cluster headache and SUNCT and SUNA are in the same family.
The key feature is that the pain is always there. A related condition, paroxysmal hemicrania, also causes one-sided pain, but in separate attacks of up to 30 minutes, five or more times a day, with no pain in between. With hemicrania continua, some pain is always present. How long the pain lasts is the main way to tell them apart.
Common symptoms
- A daily, nonstop headache on one side of the head that rarely switches sides
- Pain that is usually moderate to severe and changes in strength over the day
- Flare-ups of worse pain on the same side
- During flare-ups, feeling restless or agitated, or wanting to pace or keep moving
- On the same side as the pain: a red or watery eye, a drooping eyelid, a runny or stuffy nose, or a sweaty or flushed face
- Some migraine-like features, such as sensitivity to light
- Brief stabbing or “ice-pick” pains
Some people also notice pain around the temple muscle on that side.
What causes it
The cause of hemicrania continua is not known. Other problems can cause pain that looks similar, including blood vessel disease and disorders of the pituitary gland (a small gland at the base of the brain). This is one reason a careful exam matters.
How long it lasts is hard to predict. Some people have one episode in their lifetime. Others get relief for a while and then the headache returns.
How it is diagnosed
There is no single test for hemicrania continua. A doctor looks at the pattern of your pain and symptoms. The pain must be present for at least three months before the diagnosis can be made.
- Indomethacin trial: indomethacin is an NSAID (a type of anti-inflammatory medicine). A complete response to it is required for the diagnosis. A trial of it, supervised by a doctor, may help confirm what is going on.
- Ruling out other causes: a good response to indomethacin does not by itself rule out another cause. Doctors may order brain imaging to look for an underlying problem.
- Ruling out look-alikes: hemicrania continua can be mistaken for chronic migraine or chronic cluster headache.
A headache specialist may suspect it when migraine treatments have not helped and the pain keeps returning to the same side.
Treatment options
Indomethacin is the treatment of choice. The American Migraine Foundation describes it as the only NSAID it considers effective for this condition. Many people tolerate it well, especially at lower doses. Some get side effects such as nausea, tiredness or low mood. Because it can irritate the stomach and cause ulcers, doctors often add a medicine to protect the stomach.
Some people cannot take indomethacin, or cannot take enough of it. For them, reports describe success with other options, including:
- Gabapentin, topiramate, verapamil or melatonin
- Nerve blocks (injections of numbing medicine near a nerve)
- OnabotulinumtoxinA (Botox) injections
- Occipital nerve stimulation, a device that sends mild signals to nerves at the back of the head
With treatment, the condition is generally manageable and many people go on with normal lives. Your doctor can explain which choices fit your health history.
How Dr. Park can help
Dr. Hannah Park is a dual board-certified, fellowship-trained headache medicine neurologist with over 10 years of specialized experience, and she has lived with migraine herself. She treats trigeminal autonomic cephalalgias, including hemicrania continua.
Every patient starts with a 90-minute new patient consultation with Dr. Park ($520): a full history review, a neurological exam, a diagnosis and a personalized treatment plan. The practice focuses on targeted injection treatments, such as peripheral nerve blocks and Botox injections, rather than a cycle of prescription medications. If appropriate, an injection may be done during your first visit for an added fee. See services and fees.
Appointments are Monday to Friday, 9 a.m. to 6 p.m., usually within days. The practice is direct pay with no referral needed.
Related
Sources
This page summarizes patient information from these organizations, in our own words. It is general education, not medical advice.
- What to Know about Hemicrania Continua, American Migraine Foundation
- Hemicrania Continua, American Migraine Foundation
- What Are SUNCT and SUNA?, American Migraine Foundation
- Understanding Headache Locations, National Headache Foundation
Last updated October 27, 2026.
One-sided headache that never lets up?
Every patient starts with a 90-minute new patient visit with Dr. Park.