• Juan A Pareja, María-Luz Cuadrado, César Fernández-de-las-Peñas, Teresa Montojo, Mónica Álvarez, and Carlos López-de-Silanes.
• Fundación Alcorcón University Hospital, Alcorcón, Madrid, Spain. japareja@fhalcorcon.es
• Cephalalgia. 2012 Apr 1; 32 (5): 413-8.

BackgroundHemicrania continua was originally described as a strictly unilateral, continuous headache with an absolute response to indomethacin. Recognition of an increasing number of patients with the same clinical features except for a lack of response to indomethacin has generated controversy about whether the responsive/non-responsive phenotypes belong to the same disorder.DiscussionWe suggest that the non-responsive phenotype should be differentiated from the original concept of hemicrania continua, because it probably indicates a separate type of headache of undetermined nature, i.e. hemicrania incerta. However, differentiating hemicrania incerta from hemicrania continua does not imply that the two headaches are unrelated. Both hemicranias may outline a continuum, giving rise to a broader diagnostic field.ConclusionThere seems to be a syndrome of 'primary continuous unilateral headache' with at least two distinctive categories: hemicrania continua and hemicrania incerta, which are differentiated by their respective response to indomethacin. This division means plurality but adds precision, and allows a clear-cut diagnosis of some controversial cases.

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