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Hemicrania continua — SCE Neurology MCQ

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HardHeadacheHemicrania continuaSCE Neurology

A 63-year-old woman presented with continuous unilateral headache with superimposed exacerbations and tearing. On examination, there was ipsilateral nasal congestion during flares. Initial investigations showed: complete response occurred after an indometacin trial. What is the most likely diagnosis?

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Correct answer: D — Hemicrania continua

Hemicrania continua is the best answer because the vignette describes Hemicrania continua: absolute indometacin response supports hemicrania continua. Cerebral venous sinus thrombosis headache is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. Cluster headache and SUNCT syndrome are less appropriate because they would require different localisation, timing or test findings; Idiopathic intracranial hypertension would fit a different syndrome. Clinical pearl: chronic migraine may be unilateral but lacks the diagnostic indometacin response.

Reference: NICE CG150; BASH headache guidance; BNF