• Sarah Miller, Fernando Correia, Susie Lagrata, and Manjit S Matharu.
• Headache Group, Institute of Neurology and The National Hospital for Neurology and Neurosurgery Queen Square, London, WC1N 3BG, UK. sarah.miller.12@ucl.ac.uk.
• J Headache Pain. 2015 Mar 5; 16: 19.

BackgroundHemicrania continua is a strictly unilateral, continuous headache, typically mild to moderate in severity, with severe exacerbations commonly accompanied by cranial autonomic features and migrainous symptoms. It is exquisitely responsive to Indomethacin. However, some patients cannot tolerate treatment, often due to gastrointestinal side effects. Therapeutic alternatives are limited and controlled evidence lacking.MethodsWe present our experience of nine patients treated with OnabotulinumtoxinA for hemicrania continua. All patients were injected using the PREEMPT (Phase 3 REsearch Evaluating Migraine Prophylaxis Therapy) protocol for migraine.ResultsFive of nine patients demonstrated a 50% or more reduction in moderate to severe headache days with OnabotulinumtoxinA with a median reduction in moderate to severe headache days of 80%. Patient estimate of response was 80% or more in five subjects. The median and mean duration of response in the five responders was 11 and 12 weeks (range 6-20 weeks). Improvements were also seen in headache-associated disabilityConclusionsOnabotulinumtoxinA adds a potential option to the limited therapeutic alternatives available in hemicrania continua.

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