Hemicrania continua and paroxysmal hemicrania
One of the diagnostic criteria for both conditions is a 100% response to indometacin. An appropriate therapeutic trial is:
indometacin 25 mg orally, 3 times daily for 3 days, then 50 mg 3 times daily for 3 days, then 75 mg 3 times daily for 3 days. headache, hemicrania continua or paroxysmal hemicrania, diagnosis indometacin
If indometacin is not effective and the headache persists, stop the drug and refer to an expert for diagnosis.
If indometacin is effective, reduce it to the lowest effective dose and continue daily treatment indefinitely. Consider prevention for harms of therapy (eg add a proton pump inhibitor for a patient with risk factors for gastrointestinal toxicity; see advice).
If long-term indometacin is not tolerated, refer to an expert to try another drug—other treatment options (eg celecoxib, topiramate, verapamil, melatonin) are often only partially effective.