A case of chronic cluster headache that responded to indomethacin absolutely

Abstract

  We report a case of severe right-sided headache with ipsilateral rhinorrhea and lacrimation lasting two hours twice daily for over a year. The patient was considered to have chronic cluster headache according to the International Classification of Headache Disorders (ICHD) , but various medications were completely ineffective. Indomethacin 75 mg/day was started and the headaches resolved the next day. After seven years of treatment, the patient was able to discontinue indomethacin. There are overseas reports of the effectiveness of indomethacin in chronic cluster headache, but the doses used are high and it takes more than a week to see an effect. Although the duration and frequency of headache in this case differs from the diagnostic criteria of ICHD, it was thought to be similar to the pathophysiology of paroxysmal hemicrania because of the rapid and absolute effect of indomethacin.