Successful treatment of hemicrania continua with a combination of low-dose indomethacin and pregabalin: A case report

Abstract

A 51-year-old man complained of continuous pain lasting about 3 weeks around his forehead and left orbit - locations where pain may indicate conjunctival injection and lacrimation. Upon arrival to our hospital, his neurological examination was normal, and brain MRI showed no abnormality. The headache disappeared with indomethacin treatment (75 mg/day), and a diagnosis of hemicrania continua (HC) was established according to the International Classification of Headache Disorders, 2nd Edition. The headache returned after reducing the dose of indomethacin. After adding pregabalin (150 mg/day) to his treatment regimen, we could reduce the dose of indomethacin from 75 mg/day to 25 mg/day, which the patient tolerated well. Although HC is one of the indomethacin-responsive headaches, continuous administration can cause side effects including gastrointestinal disorders. Such side effects can decrease the tolerability of indomethacin, and may eventually lead to its reduction or discontinuation. Pregabalin can be an alternative to indomethacin for treating HC.