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Hemicrania Continua — SCE Neurology MCQ

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HardHeadache & Facial PainHemicrania ContinuaSCE Neurology

A 55-year-old woman presents with daily continuous left-sided headaches for 6 months with superimposed attacks of severe left orbital/temporal pain lasting 2–45 minutes, occurring 10–20 times per day. During attacks she has ipsilateral ptosis, miosis, lacrimation, and conjunctival injection. She has not responded to sumatriptan or oxygen. What is the most likely diagnosis?

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Correct answer: A — Hemicrania continua

Hemicrania continua is characterised by continuous unilateral headache with superimposed exacerbations accompanied by ipsilateral cranial autonomic features. The continuous baseline headache with fluctuations distinguishes it from other TACs. It is absolutely responsive to indomethacin (which is both diagnostic and therapeutic). A: Cluster headache has discrete attacks without continuous baseline pain. B: Chronic migraine does not have such prominent autonomic features. C: Paroxysmal hemicrania has discrete attacks without continuous pain. D: SUNCT has very brief attacks (5–240 seconds).

Reference: ICHD-3 (2018); ABN Headache Guidelines