Can indomethacin act as a disease modifying agent in hemicrania continua? A supportive clinical case

The natural history of hemicrania continua (HC) is not well-known. Most sufferers have the unremitting form and thus may have a lifetime duration of pain. There are only very rare cases in the literature documenting HC remission after treatment of the unremitting form with indomethacin. As the prolonged use of indomethacin can cause tremendous medical morbidity, knowledge of its true action on the course of HC is essential. The question arises: Does indomethacin have disease-modifying capacities for HC or does it just suppress the pain without altering the underlying disease pathogenesis? A case patient is presented who had indomethacin-responsive unremitting HC and after a period of daily use of indomethacin she was able to reduce her dose to one single 25-mg tablet 3 days per week and still remain pain free, suggesting disease modification. The case patient's history will be further discussed as well as the consideration that in some instances indomethacin can alter the natural history of HC.