We’re on day 25 of the never-ending headache. The good news, however, is that I have been to a neurologist who prescribed some indometacin (US: indomethacin). Indometacin is a nonsteroidal anti-inflammatory drug (NSAID), in the same broad family as naproxen or ibuprofen. It also has a rather distinctive role in diagnosing and treating indometacin-responsive headache disorders.

I have been given a suspected diagnosis of hemicrania continua. “The cause of hemicrania continua is unknown.” Well that’s probably not good. Interestingly, an absolute response to therapeutic doses of indometacin is part of the diagnostic criteria. The ICHD-3 criteria also require the headache to have been present for more than three months, so at day 25 this was still very much a working diagnosis rather than something I could tick off from a checklist.

I was taking 50mg indometacin in the morning and 50mg at night. I figured if I could get away with 2x 50mg, I was better off than having 3x 50mg. That was my own decision; dose changes need to be worked through with the prescriber. My stomach concern wasn’t imaginary: indometacin, like other NSAIDs, can cause ulcers and gastrointestinal bleeding, with the risk increasing with dose and duration. Have I checked I still have the headache? Yes! I have missed a dose on at least one occasion and it’s definitely still there. Neck, back of eye socket and scalp start to tickle(?) and then turn to pain.

Another two months until I hear from the specialist. They were kind enough to give me another MRI (with contrast this time) and apparently if I wait until late October I can have it done for free with my Health Care Card that Centrelink won’t send out.

Yes, I am still unemployed and burning through my savings. I mean they were for a future home, but maybe that’s just a pipe dream. Regardless of my upcoming homelessness, here’s the results of my MRI and I have to warn you they are quite mild.

Technique: Sagittal T1, axial T2/FLAIR, DWI ADC gradient sequences of the brain supplemented with coronal T2.

Findings: No midline shift is seen. No subdural fluid collection. No Chiari I malformation. Corpus callosum is present. No recent infarct. Small to moderate sized cavum interpositum- normal variant. Patent flow void of the Circle of Willis. Mild-moderate patchy mucosal thickening of the ethmoid air cells noted bilaterally. No recent intracranial hemorrhage.

Comment: No acute intracranial pathology detected.

I am just glad there is a way to treat the symptoms. Indometacin is not exactly gentle on the gastrointestinal tract, so hopefully it keeps working without giving my stomach something new to complain about. Probably should check and update my lucky bingo card for 2023. Hmmmmm. Oh there it is! “Primary headache disorder” - ✅ 😅

Sources