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Hemicrania continua-like headache secondary to nasopharyngeal carcinoma: A case report

A 31-year-old man presented with a four-month history of continuous left temporal pain with frequent exacerbations. The exacerbations were associated with ipsilateral conjunctival injection and a sense of restlessness. The pain entirely resolved with indomethacin (50 mg three times per day). The presentation fulfilled criteria A to D of hemicrania continua of the International Classification of Headache Disorders (1). This patient had a 20-year history of migraine, with attacks once or twice each month, and a family history of migraine. Subtle abnormalities were found on the initial brain magnetic resonance imaging scan with gadolinium enhancement (Figure 1). However, a neoplasm was excluded due to non-specific findings by fibre optic nasopharyngoscopy. At follow-up one month later, the patient had developed a left cranial nerve VI palsy. Thus a second brain magnetic resonance imaging scan with gadolinium was obtained, which revealed a