Medication-overuse headache — SCE Neurology MCQ

Correct answer: C — Complete response to a therapeutic indomethacin trial

The best answer is “Complete response to a therapeutic indomethacin trial”. Hemicrania continua is defined by continuous unilateral pain with autonomic exacerbations and an absolute response to adequate indomethacin. “Partial improvement with high-flow oxygen during an exacerbation” is less appropriate because oxygen responsiveness is associated with cluster headache but does not establish a continuous headache syndrome “Reduction in attack intensity after an oral triptan” is less appropriate because triptan benefit is non-specific and not the diagnostic criterion “Lack of response to a brief low-dose indomethacin exposure” is less appropriate because an inadequate dose and duration cannot exclude indomethacin responsiveness “Improvement after regular codeine-containing analgesia” is less appropriate because opioid improvement is non-specific and creates medication-overuse risk

Reference: NICE CG150: Headaches in over 12s — recommendations. https://www.nice.org.uk/guidance/cg150/chapter/recommendations