3.4 Hemicrania continua

A 66-year-old retired seamstress reports a headache on the left side of her head that has now been present continuously for a fraction over three months. She rates the pain as severe most of the time, and describes intermittent surges lasting an hour or so during which her left nostril feels completely blocked, as though she were coming down with a cold. She denies fever, neck stiffness, weight loss or any change in vision. She had once been given indomethacin, and recalled that at a full treatment dose her headache had disappeared completely within a day, only to return once the course finished.