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A case of remitting hemicrania continua with seasonal variation and clustering: a diagnostic confusion with cluster headache
  1. Sanjay Prakash and
  2. Kalu Singh Rawat
  1. Neurolgy, Smt BK Shah Medical Institute and Research Centre, Vadodara, Gujarat, India
  1. Correspondence to Sanjay Prakash, drprakashs{at}


Hemicrania continua (HC) is an indomethacin responsive primary headache that is characterised by a continuous strictly unilateral headache with periodic exacerbations. About 15% may have a remitting subtype of HC. Herein, we are reporting a 36-year-old man who had a 5-year history of episodic right-sided headaches. The headaches used to occur in a discrete series lasting 4–6 weeks, separated by pain-free remissions of 10–11 months. In each relapse, he had continuous background pain with superimposed exacerbations. The superimposed exacerbations were 1–2 attacks per day, lasting for 2–5 hours, and were associated with ipsilateral cranial autonomic symptoms. However, the patient did not respond to usual therapies of custer headache (CH). He had a complete response to indomethacin. We suggest that remitting subtype of HC may mimic CH. A therapeutic trial of indomethacin should be done in all strictly unilateral headaches who are not responding to other drugs.

  • headache (including migraines)
  • pain (neurology)

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  • Contributors SP and KSR were involved in conception and design. SP was involved in the acquisition of data and manuscript preparation. KSR was involved in the revising draft for intellectual content. SP and KSR were involved in the final approval of the completed manuscript. SP was the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.