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Hemicrania Continua: An Indomethacin‐Responsive Case With an Underlying Malignant Etiology

Primary nonmetastatic lung neoplasms have been reported to cause ipsilateral facial pain before the underlying malignancy is diagnosed. 1,2 This pain most commonly is described as an ache affecting the ear, jaw, or temporal region. 2 To our knowledge, however, there has been no previous description of a newly diagnosed, indomethacin-responsive case of hemicrania continua as the initial presentation of an occult lung tumor. First described by Sjaastad and Spierings in 1984, hemicrania continua is a unique primary headache disorder most commonly affecting women (5:1) in their third decade of life. 3 According to the International Headache Society (IHS) criteria, hemicrania continua is characterized by moderately severe unilateral head pain present for over a month in a continuous pattern with fluctuating severity. 4 The headache either must respond completely to indomethacin or must have at least one associated cephalic autonomic feature occurring with exacerbations of pain. 4 The autonomic features of hemicrania continua often are not as prominent as with other trigeminal autonomic cephalgias such as cluster headache or chronic paroxysmal hemicrania (CPH). 5,6 We describe a case of indomethacin-responsive hemicrania continua related to an underlying lung neoplasm, propose a potential pathophysiology, and suggest recommendations for the recognition and management of similar cases.