Hemicrania continua: Case series presenting in an orofacial pain clinic

Aim of investigation: Hemicrania continua (HC) is an uncommon primary headache and little is known of the characteristics of such patients managed in an orofacial pain setting. This study provides clinical features of HC, its association with other disorders, and treatment outcomes of patients managed in the TMD and Orofacial Pain Clinic at the University of Minnesota. Methods: A retrospective review of patient records was undertaken. Inclusion criteria were a diagnosis of HC and confirmation at follow-up. Results: Six of the 1617 new patients seen between 2015 and 2017 met the selection criteria. Four patients presented with “facial pain”, one with “toothache” and one with “jaw pain”. All were female with mean age 55 ± 10.5 years (range = 41–69). Headache characteristics included unilateral (R:L = 1:1) pain of moderate intensity with severe exacerbations in the distribution of V₁ (1/6), V₁ + V₂ (3/6) and V₁ + V₂ + V₃ (2/6). Lacrimation and photophobia were the most common associated symptoms. Patient presentations were complicated by multiple medical and comorbid diagnoses. All were diagnosed with temporomandibular disorder (TMD). Indomethacin alone was sufficient for adequate headache control in 2/6 patients with several add-on medications providing sustained pain relief. Conclusions: Comorbid pain conditions can be expected in patients with HC presenting to orofacial pain clinics. Symptom presentation varies, and multimodal treatment approach is necessary for success.