3.4 Hemicrania continua

A 40-year-old primary school teacher reports a headache restricted to the right side of her head that has now been running continuously for a little more than three months. For most of that time the discomfort has been severe, occasionally leaving her unable to concentrate, though she reports no vomiting and no sensitivity to light. She also notices several distinct spells each week during which her right eye becomes visibly bloodshot before settling back down. She tried indomethacin at an increasing dose, and on reaching a treatment-level dose her headache resolved completely within forty-eight hours; she has remained well since on maintenance treatment.