We all get headaches.

And some of us get migraines.

But only a few of us experience a migraine type headache that never stops.

This is hemicrania continua and because of its rare and continuous nature, it needs some attention.

In this article we will be talking about 5 profound clues for chronic paroxysmal hemicrania continua.

Let’s start with what it is.

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What is chronic, paroxysmal and episodic hemicrania continua?

Hemicrania continua is simple to understand when we break down the words.

Hemicrania is one sided “hemi” and headache “crania.”

It’s also continua because it continues without stopping usually called unremitting.

And it may be paroxysmal because even though it’s non stop and does not go away, sometimes it comes with spikes in pain known as paroxysms.

So we are dealing with a one sided “hemi” headache “crania” that continues “continua” chronically and with sudden spikes in pain “paroxysms.”

Chronic paroxysmal hemicrania continua.

But it may also be episodic in some even rarer cases where the pain fades and comes back(remitting).

The international headache society’s (IHS) definition of hemicrania continua is:

“Persistent, strictly unilateral headache, associated with ipsilateral conjunctival injection, lacrimation, nasal congestion, rhinorrhoea, forehead and facial sweating, miosis, ptosis and/or eyelid oedema, and/or with restlessness or agitation. The headache is absolutely sensitive to indomethacin.”

Indomethacin is the main standard treatment used for hemicrania continua and we will talk about it later because it’s a very strong anti inflammatory.

Here is a video of what chronic paroxysmal hemicrania feels like.


Most common symptoms of hemicrania continua

The IHS definition already covered some symptoms but let’s look at what a study of 54 patients with hemicrania continua found the most common symptoms were.

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The most common presentation is for the pain to come side locked with symptoms on that side of the body.

  • It usually stays on that side and includes:
  • Teary eyes
  • Congestion and mucus
  • Red or itchy eyes
  • Eye pain
  • Drooping eyelids
  • Flushing
  • Runny nose

And many many more.

Even though it’s known to be side-locked pain, meaning it stays on the area that it starts, in some cases it moves around because as we know, the labels we put on diseases are just that, labels that we use to understand reality but not actual reality.

Below is a graph of all the areas that the attacks may happen listed by frequency found in the study.

​ 

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Now lets understand what the main reported causes of aggravating hemicrania continua are.

What makes hemicrania continua worse / Triggers for flares

Before I give you a list of the most commonly reported symptoms and triggers it’s important to look at headaches and migraines as an inflammatory issue.

Inflammation is the body’s natural response to stresses whether they be mental, emotional, physical, dietary, environmental etc.

A little bit of inflammation and stress is good but having a lot, all of the time means our lifestyle is severely out of sync with our body’s needs.

When the stress builds up too high in any one system of the body, it starts to spill over to the others and inflammation results.

As the inflammation builds and more systems have to start compensating for the primary problem, your body uses pain as a way of signalling to you that you have to stop what you are doing.

This will become clearer when we get into the standard treatments and clues sections.

Here is a table showing the most commonly reported symptoms of hemicrania continua in a study of 54 patients.

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Notice anything peculiar?

These are all the same triggers as headaches and migraines…

Because headaches and migraines largely fall under the same mechanisms and even though they come in many different labels and severities, they happen in the same body.

What are some of the most common causes of a leaky brain?

Look at the top 3.

Yep that’s right it’s stress, alcohol and bad sleep.

Everything’s connected and when we can understand the system that first started to go under, we can understand how our condition developed.

For some it may have been emotional stress from a trauma.

For others it may be hormonal imbalances made worse by menses.

Others it may be food triggers because of a dysfunctional gut.

Etc. Etc. Etc.

Find the root and what started it all and work your way back.

If you don’t know what it is or need help then ask a professional or start the 10 steps.

Standard treatments for chronic or episodic paroxysmal hemicrania continua

As per the IHS guidelines, one of the ways the hemicrania continua is identified is by its responsiveness to a medication called indomethacin.

Indomethacin is an NSAID which means its a non steroidal anti inflammatory drug.

The key here is to understand that it is anti-inflammatory.

If a condition is found to be responsive to an anti inflammatory drug, then shouldn’t we understand what it’s trying to stop the inflammation of?

Shouldn’t we understand why there is inflammation and look at known causes of inflammation first and reduce them?

The body does not inflame for no reason.

There is always a reason.

See our articles on complex and complicated migraines, what to do when a headache won’t go away, migraine prodromes and migraine postdromes and ocular migraines in the respective links.

5 Profound clues that you need to look into for chronic paroxysmal hemicrania continua

1. Understand trigger and threshold levels

First and foremost we have to understand that our head pain and any “flare” of pain unless it’s from an acute accident and it’s a post traumatic headache needs to be looked at through the lense of trigger and threshold levels.

Our trigger level is how high of a stress load all the stresses or “triggers” are on our body’s sensors.

Our body is always using what is called nociception which is combining the sum total of all of the stresses on it.

That may be our dairy intolerance and our love for dairy food combined with our period coming up and hormonal imbalances combined with work stress giving us bad sleep and relationship issues keeping us wound up and worried all day.

These all add to our trigger level because they are stresses on our body.

Then we have our threshold level.

Threshold is the level that if we cross, we will trigger symptoms.

This is the level that once our trigger level crosses it, our body can no longer maintain normal “homeostasis” or normal functioning and it starts to go into the flare state to protect itself and release as much stress as possible without causing permanent damage to tissues like our brain.

Our threshold is basically the amount of tolerance that our body has, just like the amount of tolerance that we have for things like children or bad jokes.

We want to keep threshold high by increasing our body’s tolerance.

This comes through two things, healing our body and our desire to change how our genes act.

Genes are constantly turning on and off and something as simple as getting direct sunlight every day influences 500+ switches on your epigenetics.

This goes hand in hand with healing our body and the integrity of our systems.

Life isn’t always easy and it’s usually not at all but when we have been building up strong resilient systems for our entire lives, just because we go through a period of extreme strain and one of our systems gets overloaded, doesn’t mean it will spill into the others and gives us a disease.

This is why healing our body goes long passed once we have gotten to a baseline of health because we can continue to build resilience and raise our threshold indefinitely.

This is why I don’t experience migraines anymore because I’ve put in the work over many years and my body can compensate for any stresses very well.

2. Look for the causal system

This is key to finding the BIGGEST win we can get towards fixing the disease.

But it can be tricky because some causes happened years and years ago and we have since start loading up other things onto our body and carry around lots of baggage.

Just like cancer is now understood to have taken 10 years to develop, being pushed to the point of chronic head pain like hemicrania continua is not an overnight occurrence unless we have a severe injury in which case it’s not hemicrania and is post traumatic headache.

So we want to ask ourselves questions and trace it back.

We need to know:

What is our pain pattern? how does it develop, what causes it and what starts it whether that be stress, foods, sleep etc. What is the series of events that ends in flare?

Which one of our systems are showing symptoms apart from the main complaints flare and which one started first?

– Whether that be PMS with menses, food cravings or bloating, sleep disturbance, structural issues like neck tightness etc. These all point to an area and this is why it’s important to look at your body integratively and functionally.

Was there any big event within a year before our head pain started?

There’s many more questions to ask and this is why I recommend speaking with a professional but these are the main ones to start and dive deeper into.

3. Get the right testing

When things don’t make sense, get tested.

If you’re not testing, you are guessing.

You could have 3 autoimmune diseases, 5 dozen symptoms and then hemicrania continua shows up into your life…

But you want to know what is underlying it all and testing shows you exactly what’s going on.

What if you’ve had a severe intestinal parasitic infection that’s progressed for years and slowly overloaded your digestion, then detoxification, then hormones and now the inflammation is running rampant in your brain?

You want to test, assess and not guess.

This is why a functional medicine practitioner is a huge help.

4. Fix leaky brain

The brain has a barrier called the blood brain barrier(BBB) that lets in nutrients and keeps out harmful bacteria, chemicals and substances.

Just like our gut has a barrier that lets in nutrients and keeps everything else in our intestines so that it can get pooped out.

But this BBB is only one cell thick and can become damaged from things like sleep, stress, alcohol, EMFs, inflammation etc.

So we want to help repair it and this is when sleep is absolutely essential.

The average person needs 7-8 hrs of sleep.

If you are sick and especially if it’s chronic, you need 9 minimum.

You have to find a way to get good, restful sleep.

And it can be so hard with chronic pain but there are many ways to go about it and you need it.

See our foundation principles and weekend headaches articles for sleep tips.

5. Do you need natural anti inflammatory support from superfoods?

When in a chronic flare, you need every tool in the box.

Food is your ultimate healing tool and without good food, medicine will do little to address the cause.

Here are 7 amazing anti inflammatory superfoods for calming the brain fire:

  • Organic virgin cold pressed coconut oil
  • Turmeric + black pepper
  • Ginger
  • Broccoli sprouts
  • Everything green and leafy
  • Celery juice
  • Pomegranate

Through understanding our body and understanding everything that happened and is connected to the main symptoms we are experiencing that are causing discomfort in our lives we can get to the root.

When we can get to the root cause and address it we will be much more successful in the long term and actually fix the issue instead of just masking symptoms with medications and hoping another system doesn’t break.

To get a deeper understanding of how headaches and migraines affect the body join the Migraine Professional community here.

Comment below and tell me your experiences with hemicrania and share with others that need some help.

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