title: Melatonin responsive hemicrania continua in which indomethacin was associated with contralateral headache.
abstract: Headache is a well-documented side effect of indomethacin in the older medical literature; however, it has rarely been commented on in indomethacin-responsive hemicrania continua. We describe the case of a 60-year-old woman with left-sided hemicrania continua whose indomethacin treatment was associated with a continuous right-sided migraine. Her indomethacin therapy was discontinued heralding a return of her left-sided hemicrania continua and a resolution of her right-sided migraine. Her hemicrania continua then responded well to melatonin, with recurrence on stopping and improvement on restarting. This is the most detailed description of headache as a side effect of indomethacin in a headache patient we are aware of, and one of only a few reported cases of melatonin-responsive hemicrania continua. We review the evidence of headache as a side effect of indomethacin in order to highlight its importance in the treatment of headache disorders. We emphasize that indomethacin headache response may be more than simply a beneficial or neutral one and might be relevant to some cases of apparently indomethacin-resistant hemicrania continua. We hope this case may encourage clinicians to inquire about headache as a potential side effect of indomethacin.
authors.affiliation: University College London Medical School, London, UK.
authors.forename: Milo
authors.initials: M
authors.lastname: Hollingworth
authors.forename: Tim M
authors.initials: TM
authors.lastname: Young
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D002492:Central Nervous System Depressants / Q000627:therapeutic use*; D005260:Female; D006261:Headache / Q000139:chemically induced*; D006801:Humans; D007213:Indomethacin / Q000009:adverse effects*; D008550:Melatonin / Q000627:therapeutic use*; D008875:Middle Aged; D008881:Migraine Disorders / Q000188:drug therapy*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D002492:Central Nervous System Depressants; D008550:Melatonin; D007213:Indomethacin
keywords: hemicrania continua; indomethacin; indomethacin-resistant hemicrania continua