What is Indomethacin Responsive Headache

Indomethacin responsive headache is a headache that gets better when you take indomethacin. Indomethacin is a kind of NSAID (nonsteroidal anti-inflammatory drug). Indomethacin can quickly stop the pain from some kinds of headaches, such as:

• Paroxysmal hemicrania. This is a series of short, severe headaches, usually on just one side of the head.
• Hemicrania continua. Pain is nonstop and on one side of the face.
• Primary exertional headache. Exercise sets off these headaches.
• Primary cough headache. Pain may come from pressure in the brain when coughing or straining.

What are the causes?

The exact cause of this condition is not known. Certain conditions may start (trigger) a headache. They include:

• Moving the head in certain ways.
• Stress.
• Pressure on sensitive areas of the neck.
• Drinking alcohol.
• Exercise.
• Coughing and sneezing.

What increases the risk?

The following factors may make you more likely to develop this condition:

• Being 30 years of age or older.
• Having a serious head injury.
• Having migraine headaches.
• Having a family history of this condition.

What are the signs or symptoms?

Symptoms of this condition depend on the kind of headache you have.

• Paroxysmal hemicrania:
  • Having about 10 headaches a day. Each may last from a few minutes to 2 hours.
  • Severe, pounding pain.
  • Pain usually on just one side of the head. It often centers around the eye or in the forehead.
  • A watery eye, which may become red or swollen.
  • A droopy or swollen eyelid.
  • Sweating and having a red or pinkish face.
  • A stuffy, runny nose.
• Hemicrania continua:
  • All-day headache. This may occur daily for at least 3 months. Then there may be no headaches for weeks or months.
  • Pain that gets worse several times during the day.
  • Pain in the face, on one side only. It almost always occurs on the same side.
  • A watery eye. It may also become droopy, red, and swollen.
  • A stuffy, runny nose.
  • Pain that gets worse with sound or light.
• Primary exertional headache:
  • Pain during physical activity.
  • Pounding or throbbing pain.
  • Pain that lasts for 5 minutes to 48 hours, or sometimes longer.
• Primary cough headache:
  • Pain that starts after coughing, sneezing, or straining.
  • Sharp, stabbing pain.
  • Pain on both sides of the head. It is often worse in the back of the head.
  • Pain that is severe for a few minutes and then dull for several hours.

How is this diagnosed?

This condition may be diagnosed based on:

• Symptoms and medical history. Your health care provider will ask you questions about your headaches.
• Physical exam.
• Tests that may include:
  • Blood and urine tests.
  • Spinal tap (lumbar puncture). This tests a sample of fluid from your spine. The test checks for infection, bleeding in your brain (brain hemorrhage), or extra pressure inside your skull.
  • Ultrasound, MRI, CT scan, or other imaging tests.

If no medical condition is causing your headaches, you will be given indomethacin. If yours is an indomethacin-responsive headache, your symptoms should go away quickly.

How is this treated?

• By taking indomethacin.
• With other medicines:
  • To prevent or treat stomach ulcers.
  • To relieve stomachache or heartburn (antacids).
  • For nausea.

Follow these instructions at home:

Lifestyle

• Rest in a dark, quiet room.
• Put a cool, damp washcloth on your head or face.
• Get plenty of sleep. Most adults should get at least 7–9 hours of sleep each night.
• Eat on a regular schedule. Do not skip meals.
• Limit alcohol intake to no more than 1 drink per day for non-pregnant women and 2 drinks per day for men. One drink equals 12 ounces of beer, 5 ounces of wine, or 1½ ounces of hard liquor.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.

Headache diary

Keep a headache diary. This will help you and your health care provider determine what is triggering your headaches. Each time you have a headache, write down:

• When it started and stopped. Include the day and time.
• How it felt.
• Any triggers, such as noise, stress, or foods.
• Any medicines you took.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
  • Do not take other NSAIDs, such as ibuprofen, with indomethacin.
• Tell your health care provider about all medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• Your pain continues even with treatment.
• You have nausea.
• You have a fever.

Get help right away if:

• You have bad stomach pain or vomiting.
• You vomit blood.
• You have blood in your stool.
• You have chest pain.
• You have any symptoms of a stroke. “BE FAST” is an easy way to remember the main warning signs of a stroke:
  • B – Balance. Signs are dizziness, sudden trouble walking, or loss of balance.
  • E – Eyes. Signs are trouble seeing or a sudden change in vision.
  • F – Face. Signs are sudden weakness or numbness of the face, or the face or eyelid drooping on one side.
  • A – Arms. Signs are weakness or numbness in an arm. This happens suddenly and usually on one side of the body.
  • S – Speech. Signs are sudden trouble speaking, slurred speech, or trouble understanding what people say.
  • T – Time. Time to call emergency services. Write down what time symptoms started.
• You have other signs of a stroke, such as:
  • A sudden, severe headache.
  • Nausea or vomiting.
  • Seizure.

Summary

• An indomethacin-responsive headache is a headache that gets better when you take indomethacin, a medicine that stops inflammation.
• The exact cause of this condition is not known, but there are certain conditions that may start (trigger) a headache.
• Keep a headache diary to help your health care provider determine your triggers.
• Treatment of this condition includes indomethacin, but it may include other medicines to relieve other symptoms.