Indomethacin-responsive headaches

Chronic and episodic paroxysmal hemicrania and hemicrania continua are rare types of headaches that have one common feature – they respond very well to indomethacin (Indocin). The diagnosis is actually based not only on clinical features but also on the response to indomethacin. Indomethacin belongs to the category of NSAIDs (non-steroidal anti-inflammatory drugs) such as aspirin, ibuprofen, naproxen, and other. Indomethacin is somewhat unique in the way it works and it is often stronger, however it also causes more gastrointestinal side effects than other NSAIDs. Symptoms of paroxysmal hemicrania are similar to those of cluster headaches: the pain is very severe, very brief (lasting a few minutes) and occurs anywhere from a few times to a few hundred times a day. The pain is always one-sided, localized to the eye and it is often accompanied by tearing, nasal congestion, and redness of the eye. Hemicrania continua is very different in that it is present constantly and it is not very severe, but it also involves only one side of the head. Hemicrania continua is often mistaken for chronic migraine or chronic tension-type headache, which leads to ineffective treatments. The dose of indomethacin varies from 25 to 75 mg, taken three times a day. Some patients with these headache types do not tolerate indomethacin, which can cause heartburn, stomach ulcers, bleeding ulcers and other side effects. In those patients we try epilepsy drugs, other NSAIDs (which may or may not be better tolerated), as well as Botox injections and sometimes these treatment do help, if not as well as indomethacin, at least enough to improve patients’ quality of life.

5 comments
  1. shuhlann says: 10/11/201710:03 pm

    After suffering from hemicrania continua for over a year, I finally talked to my primary, who referred me to my neurologist. Oh, and my ophthalmologist weighed in on it, too. Anyway, the neurologist prescribed indomethacin, and I was not impressed at first. I am 66 yrs old and have issues with my balance; my first dose of indomethacin made me feel a bit woozy so I didn’t take it again until recently. When I got tired of swallowing ibuprofen with my current attack of hemicrania, I decided to try the indomethacin again – on a day when I could relax at home and not worry about balance or driving. Of course I was pleased with the relief from the headache. And after an hour or two, there was no wooziness. But the biggest surprise was that the hemicrania did not recur the next day. Late on the 3rd day it came back so I took the indomethacin again. This pattern seems to happen again and again now. Does anyone else have this experience?

  2. Dr. Mauskop says: 07/07/201212:32 am

    What is the second layer besides indomethacin? You would need to check with a medicinal chemist to make sure the two drugs do not interact.

  3. Abhishek Chakraborty says: 07/07/201212:08 am

    Dear sir/madam

    I want to make of bilayered tablet formulation for arthritis. My question is whether indomethacin can be used? Awating for your reply.

    Thanking you,
    With regrds,
    Abhishek Chakraborty.
    email- abhi.careerboy@gmail.com
    mob- 08892646632

  4. Dr. Mauskop says: 06/07/20129:34 pm

    If indomethacin is effective, there is no reason to try experimental and invasive treatments such as implanted stimulators. However, if indomethacin is cuasing side effects (the most common ones are stomach-related), then you may want to try other drugs and Botox injections before having stimulators implanted.

  5. Lauren says: 06/07/20126:54 pm

    Hi Dr. Mauskop- I’ve been living with HC for 7 months now. Indomethacin has been a wonderful drug for me (i’ve tried topamax, too)- However, I understand that patients can have HC for many years. I’ve done some research of my own (not always a good idea) and was wondering what your take on other methods are, such as occipital nerve stimulation.

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