What is indomethacin-responsive headache and which diagnosis is classic?

Prepare for the Pharmacology IV – Headache Therapeutics Test. Review the therapeutic approaches, tackle multiple-choice questions with explanations, and boost your test-taking confidence. Ace your exam with precision!

Indomethacin responsiveness is a defining feature of certain trigeminal autonomic cephalalgias, with the classic example being hemicrania continua. This condition is a chronic, strictly unilateral headache that persists day after day for months or years, sometimes with more intense exacerbations and on-the-same-side autonomic symptoms. The key diagnostic clue is a complete and sustained relief with a therapeutic trial of indomethacin, often at a low dose; if the pain goes away entirely and remains controlled on ongoing indomethacin, the diagnosis is supported.

Migraine with aura tends to be episodic and can involve sensory aura before attacks, but it is not a continuously daily unilateral pain that resolves solely with indomethacin. Tension-type headache is typically bilateral and non-pulsatile, without the exclusive indomethacin-responsive pattern. Cluster headache features very severe unilateral attacks with autonomic symptoms and a circadian rhythm, but it is predominantly episodic rather than a continuous daily pain that is completely relieved by indomethacin.