What Is the First-Line Treatment for Hemicrania Continua?

Hemicrania continua is a primary headache disorder defined by persistent, strictly unilateral head pain. Managing it effectively requires both controlling acute exacerbations and establishing prolonged preventive treatment — and there is a clearly identified first-choice agent for both goals.

The core treatment target is relief of the unilateral headache pain. Patients who achieve at least partial relief qualify as responders; those who reach complete pain freedom are classified as complete responders.

Indomethacin is established as the first-choice treatment — used for both recurrent exacerbation management and as a sustained preventive strategy. The full protocol specifies dosing for adults and children, available routes of administration, and guidance for patients who cannot tolerate this agent.

Complete regimen details — doses, routes, duration, and escalation criteria — are in the structured protocol below.