If you’re living with headaches or migraines—whether they’re sharp and fast, slow and steady, or scattered like lightning bolts across your skull—you probably know that no two headaches feel the same. And yet, there are so many types that go undiagnosed for years, leaving people in pain and confusion, wondering, “Is this just how life is now?”

One of the lesser-known types of headache is called Hemicrania continua. It’s rare, often misdiagnosed, and often misunderstood—especially by people who’ve never lived in a body that hurts more days than it doesn’t.

So let’s slow down and break this down together—gently, clearly, and with compassion.

First, What Is Hemicrania Continua?

Hemicrania continua (HC) is a chronic, one-sided headache that doesn’t go away. The pain is constant—every single day—and it always affects only one side of the head. It can fluctuate in intensity, but it never fully disappears.

It’s not just “a bad headache.” It’s more like a background hum of pain that sometimes grows into a roar.

The hallmarks of HC:

✅ Continuous pain on one side of the head (never switches sides)
✅ Mild to moderate pain most of the time, with occasional spikes
✅ Sharp, stabbing, or throbbing flares that last from minutes to hours
✅ Associated symptoms like eye redness, tearing, nasal congestion, or drooping eyelid (usually on the painful side)
✅ Immediate, total relief with indomethacin, a powerful anti-inflammatory medication

It’s that last point—the response to indomethacin—that makes hemicrania continua unique. If the headache doesn’t respond to this drug, it’s not HC. That’s how doctors usually confirm the diagnosis.

What It Feels Like (In Real Life Terms)

Sometimes, the textbook descriptions fall flat. So here’s what people with hemicrania continua often describe:

“It feels like someone is pressing a hot coin into my temple every day.”
“It’s like a migraine that never leaves.”
“The pain dips and rises, but it’s always there.”
“My eye gets red and watery. Sometimes my nose runs. It feels like my face is melting.”
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“People think I’m exaggerating because I look ‘fine’ on the outside.”

And maybe that resonates with you, or maybe it doesn’t—but if you’re someone who lives with invisible pain, then you already understand how isolating it can be when no one seems to have a name for what you’re going through.

Symptoms That Often Come Along for the Ride

In addition to constant head pain, people with HC might experience:

Eye redness or tearing on the affected side
Drooping eyelid (ptosis)
Runny or blocked nostril
Sensitivity to light or sound
Nausea
Restlessness or agitation during pain spikes

These symptoms can overlap with cluster headaches or migraines, which is part of why HC gets misdiagnosed so often.

How Is It Diagnosed?

Hemicrania continua isn’t diagnosed with a blood test or brain scan (although those may be used to rule out other conditions). Instead, the diagnosis depends on:

History and symptoms
A response test with indomethacin

Doctors will often prescribe a short trial of indomethacin (sometimes called an “Indotest”). If the headache completely vanishes within a few days, it’s a strong confirmation of HC.

If it doesn’t? Then the doctor might explore other types of headache, such as chronic migraine, new daily persistent headache, or paroxysmal hemicrania.

What Causes It?

Unfortunately, we still don’t know exactly why HC happens. Like many chronic headaches, it’s thought to involve nerve pathways and inflammation, especially involving the trigeminal-autonomic reflex. That’s a fancy way of saying the systems in your brain that control pain, blood vessels, and facial functions may be misfiring.

What we do know: It’s not caused by stress or lifestyle. It’s a neurological condition—and it’s real.

Treatment: The One Drug That Works

Here’s where things are strangely specific.

The only medication known to fully stop hemicrania continua is:

Indomethacin – a nonsteroidal anti-inflammatory drug (NSAID)
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People who respond to indomethacin usually find full relief within 48–72 hours. However, it’s a strong drug, and long-term use can come with side effects like:

Stomach pain or ulcers
Heartburn
Increased risk of bleeding

So doctors may also prescribe stomach-protecting medications (like omeprazole) alongside indomethacin.

For people who can’t tolerate indomethacin, alternatives like celecoxib, topiramate, or nerve blocks may be considered—but they’re generally less effective.

Living With It: Things That Can Help

While indomethacin might control the physical pain, living with any chronic condition takes a toll. Here are some things that might help ease the emotional load:

Pace yourself – You don’t have to prove your pain. Rest is not weakness.
Keep a headache journal – Tracking flares, symptoms, and patterns can help, even just for your own validation.
Connect with others – Online groups, like this one, can offer validation and insight.
Use scripts for explaining your condition – You don’t owe anyone a medical seminar, but having words ready can help.

Summary

If you’ve been living with a one-sided headache that never fully goes away, you are not making it up. Hemicrania continua is rare, but it’s real—and treatable. Getting a proper diagnosis can be life-changing, especially when the right medication works almost like a light switch.

So keep asking questions. Keep advocating. And know that even if your pain has been invisible, you are not.