title: Rigorously defined hemicrania continua presenting bilaterally.
abstract: BACKGROUND
  Hemicrania continua (HC) is a headache syndrome characterized by continuous, unilateral head pain, autonomic features, and a complete therapeutic response to indomethacin. Although HC is classified as a unique entity among primary headache disorders, it clearly shares features with other primary headaches, including trigeminal autonomic cephalalgias, and chronic daily headaches, such as chronic migraine and chronic tension-type headache. In addition, the diagnosis is often delayed secondary to a relatively low incidence and the occurrence of some phenotypic variability as found in previous case series.
  
  
  METHODS
  A 62-year-old woman presented with 5 months of unremitting, bilateral headache with significant autonomic symptoms during exacerbations of pain. Neurological examination and imaging studies were normal. After failure to respond to numerous previous therapeutic medicines and interventions, she experienced complete resolution following administration of indomethacin and eventual remission on sustained treatment.
  
  
  CONCLUSIONS
  This case demonstrates that hemicrania continua with requisite autonomic features can occur in a purely bilateral form. Although the definitive aspects of HC continue to evolve, a bilateral headache meeting the current criteria warrants a therapeutic trial of indomethacin.
authors.affiliation: University of Virginia Health System, Charlottesville, 22908, USA. as5ef@virginia.edu
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Southerland
authors.forename: Ivan S
authors.initials: IS
authors.lastname: Login
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001342:Autonomic Nervous System Diseases / Q000145:classification / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D007839:Functional Laterality; D006801:Humans; D007213:Indomethacin / Q000627:therapeutic use*; D008875:Middle Aged; D051302:Paroxysmal Hemicrania / Q000145:classification / Q000175:diagnosis* / Q000188:drug therapy*; D012074:Remission Induction
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D007213:Indomethacin