skip to main content

Hemicrania Continua – Indomethacin Response — SCE Neurology MCQ

Instant feedback + full explanation. One question, done properly.

ModerateHeadache & Facial PainHemicrania Continua – Indomethacin ResponseSCE Neurology

A 45-year-old woman presents with severe unilateral headache strictly on the right side, occurring daily for 3 years. The headache is continuous with moderate-intensity baseline punctuated by exacerbations with ipsilateral autonomic features (lacrimation, conjunctival injection, nasal congestion). She has tried sumatriptan and oxygen without benefit. A trial of indomethacin 75 mg TDS produces complete resolution within 48 hours. When indomethacin is stopped, the headache returns. What confirms the diagnosis?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — The absolute response to indomethacin — this is pathognomonic for hemicrania continua

Hemicrania continua is defined by an absolute and complete response to indomethacin — this is both a diagnostic criterion (ICHD-3) and the treatment. The headache is continuous and unilateral with autonomic features during exacerbations. Lack of response to triptans/oxygen distinguishes it from cluster headache. Indomethacin must be taken continuously as the headache returns on cessation. For patients who cannot tolerate indomethacin (GI side effects), alternatives include COX-2 inhibitors or occipital nerve stimulation. A: Triptans are ineffective. C: Imaging confirms no secondary cause but doesn't make the diagnosis. D: Continuous nature is necessary but not sufficient. E: Paracetamol response would not confirm HC.

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