Hemicrania is a rare one-sided headache disorder that may cause continuous or recurring head pain, often with eye tearing, nasal congestion, facial sweating, restlessness, or other autonomic symptoms.
Persistent one-sided headaches may be caused by hemicrania. Dr. Siefferman explains how this condition is diagnosed and the treatment options available to help relieve pain and restore quality of life.
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Hi, I’m Dr. Jason Siefferman, medical director of Manhattan Pain Medicine and board-certified headache specialist. Hemicrania occurs as paroxysmal hemicrania, which happens paroxysmally intermittently, and hemicrania continua, which is persistent, consistent, and goes on for some period of time. And ironically, either of these, even though they’re called hemicrania, can evolve to include the whole head.
Typically these are more common in women, unlike cluster, which is more common in men, and are also a subtype of trigeminal autonomic cephalgia, which means that there is some level of dysautonomia that occurs with this headache. Generally, there is restlessness or agitation; that sympathetic hyperactivity sort of boils through. And then there’s often tearing, sinus congestion, droopy eyelid, something along those lines, and often there’s light sensitivity just in that one side.
The pattern of the headache, meaning the intervals in which it occurs and the durations of the spikes of the headache, are what differentiate it from cluster headache, and also its responsiveness to indomethacin, which is an anti-inflammatory which is rather unique in its structure. And unlike any other anti-inflammatory, indomethacin can break hemicrania, and this is the defining characteristic of paroxysmal hemicrania or hemicrania continua.
So it’s one of the initial diagnostic tests that we use, but it’s also an abortive treatment that we use. In addition, there are a number of other medications, sphenopalatine ganglion blocks, IV infusions, nerve blocks, other things we can do to help get this under control. So if you are suffering from these, please come see us; we have a number of tools that can help.
Hemicrania refers to rare headache disorders that cause strictly one-sided head pain. The two main forms are hemicrania continua and paroxysmal hemicrania. Hemicrania continua usually causes continuous one-sided headache lasting for months, with periods of worsening. Paroxysmal hemicrania causes shorter, severe one-sided attacks that may happen many times per day.
Both conditions can include autonomic symptoms on the same side as the pain, such as eye tearing, eye redness, nasal congestion, runny nose, eyelid changes, facial sweating, or restlessness. Because these symptoms can overlap with migraine, cluster headache, sinus headache, TMJ disorders, trigeminal neuralgia, cervical pain, and other headache conditions, diagnosis-first evaluation is essential.
At Manhattan Pain Medicine (MPM), evaluation begins by understanding the headache pattern, attack duration, frequency, location, associated autonomic symptoms, prior medication response, and red flags. The goal is to determine whether symptoms fit hemicrania or another headache or facial pain condition before building a treatment plan.
For patients looking for hemicrania treatment in NYC or Manhattan, MPM evaluates the full headache pattern before recommending care. This includes reviewing whether pain is continuous or attack-based, whether it is always on the same side, whether autonomic symptoms are present, and whether prior treatment for migraine, sinus headache, cluster headache, TMJ, or facial pain has helped.
Care may include medication management, careful review of whether an indomethacin trial is clinically appropriate, coordination with neurology when needed, and supportive treatments such as biofeedback, pain psychology, acupuncture, or selected procedures when another pain generator is identified.
MPM does not assume that every one-sided headache is hemicrania. The evaluation also considers migraine, cluster headache, trigeminal autonomic cephalalgia, trigeminal neuralgia, tension headache, cervicogenic headache, TMJ-related headache, sinus disease, medication overuse headache, and other neurologic or medical causes.
Hemicrania can be difficult to recognize because it is rare and can resemble more common headache disorders. Some patients are treated for migraine, sinus headache, tension headache, TMJ-related pain, or cluster headache before the pattern becomes clear.
The details matter. Hemicrania continua is usually a constant one-sided headache that persists for more than three months, with episodes of worsening and possible autonomic symptoms. Paroxysmal hemicrania usually causes shorter, severe one-sided attacks that may happen several times per day. Both conditions are known for a strong response to indomethacin when the diagnosis is accurate, but this medication is not appropriate for every patient.
MPM’s diagnosis-first approach helps determine whether the headache pattern truly suggests hemicrania, whether additional evaluation is needed, and whether treatment should involve headache medication, coordinated specialty care, or evaluation of overlapping cervical, facial, jaw, autonomic, or chronic pain contributors.
Hemicrania fits within MPM’s Headache Zone of Expertise, with important overlap in Autonomic dysfunction because symptoms may include eye tearing, nasal congestion, eyelid changes, facial sweating, pupil changes, or restlessness.
These features can resemble sinus symptoms, eye symptoms, or other facial pain conditions, but when they occur with strictly one-sided headache, they may point toward a trigeminal autonomic headache disorder.
MPM evaluates these symptoms in context, including headache timing, duration, laterality, medication response, neck and jaw overlap, and whether the condition may be hemicrania, cluster headache, another TAC, migraine, trigeminal neuralgia, or another pain pattern.
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The best care I've received as a chronic pain patient. I traveled from out of state to visit Manhattan Pain Medicine because I could not find knowledgeable doctors in my hometown for my hypermobility, and Ehlers-Danlos syndrome symptoms and comorbidities. Let me tell you, it was worth every travel e...
I was injured in a bicycle accident over 8 years ago. I’ve suffered throughout the years since my accident with nothing seeming to work. PT, Yoga, lifestyle changes, NOTHNG! I finally made an appointment with Dr Kane and I’m feeling an improvement in my life. I no longer stay up all night in pain, a...
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I have very unique & severe nerve pain from CRPS which has no known specific cure. Dr. Siefferman has a huge tool box, far greater than the other 23 Drs. I have seen. He saved me from jumping off a bridge and continues to help me with both treatments and advice. Dr. S. is in a different league!
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The staff was friendly and helpful. Dr. Siefferman was thoughtful, listened, asked questions and proposed simple safe ways to come to further conclusions regarding my pain and discomfort. The office staff including Dr. Siefferman is responsive even after the initial in-person visit. Very pleased.
Dr. Siefferman is a brilliant provider. While my pain is still a work in progress, Dr Siefferman always gives me options and explains his reasoning behind things. He listens to my feedback and concerns. I never feel rushed; and am grateful he works to meet me where I am. I highly recommend him.
What a great find! They listen to me, I listen to them and the diagnosis is made and a plan developed to develop an approach to treat all of my chronic pain. I wish I could have discovered this type of treatment sooner. This doctor and group give me hope.
Hemicrania is a group of rare headache disorders that cause pain on one side of the head. The two main types are hemicrania continua and paroxysmal hemicrania. These headaches may include autonomic symptoms such as eye tearing, eye redness, nasal congestion, runny nose, eyelid changes, facial sweating, or restlessness. Because hemicrania can resemble migraine, cluster headache, sinus headache, TMJ disorders, or other facial pain conditions, careful evaluation is important.
Hemicrania continua usually causes continuous one-sided headache lasting more than three months, with periods of worsening. Paroxysmal hemicrania usually causes shorter, severe one-sided attacks that may happen many times per day. Both conditions may include autonomic symptoms and are known for a strong response to indomethacin when the diagnosis is accurate.
No. Hemicrania and migraine are different headache disorders, although symptoms may overlap. Migraine may cause throbbing pain, nausea, light sensitivity, sound sensitivity, aura, and functional impairment. Hemicrania is typically strictly one-sided and may include autonomic symptoms such as tearing, nasal congestion, eyelid changes, or restlessness. A careful headache history helps distinguish them.
No. Hemicrania and cluster headache are both one-sided headache disorders that may include autonomic symptoms, but they differ in attack pattern, duration, frequency, and medication response. Cluster headache usually causes severe attacks lasting 15 to 180 minutes and often occurs in cluster periods. Paroxysmal hemicrania attacks are typically shorter and more frequent. Hemicrania continua is usually continuous. Diagnosis should be made based on the full clinical pattern.
Hemicrania usually causes pain on one side of the head. The pain may feel steady, aching, sharp, stabbing, throbbing, or severe during flares. Some patients also experience eye tearing, red eye, nasal congestion, runny nose, eyelid swelling, facial sweating, pupil changes, eyelid drooping, or restlessness on the same side as the pain.
Yes. Hemicrania can include autonomic symptoms on the same side as the headache. These may include tearing, red eye, nasal congestion, runny nose, eyelid swelling, facial sweating, eyelid drooping, pupil changes, or restlessness. These symptoms can cause hemicrania to be mistaken for sinus headache, eye problems, cluster headache, or other facial pain disorders.
Diagnosis begins with a detailed headache history, including pain location, duration, frequency, side consistency, autonomic symptoms, triggers, prior treatment response, and red flags. Clinicians may review neurologic findings, medication history, prior imaging, and other evaluations. A carefully supervised indomethacin trial may be considered when the clinical pattern suggests hemicrania, but this is not appropriate for every patient.
Hemicrania continua and paroxysmal hemicrania are known for a strong response to indomethacin. When the headache pattern fits and the medication is safe for the patient, response to indomethacin can help support the diagnosis. However, indomethacin can carry gastrointestinal, kidney, cardiovascular, bleeding, and medication-interaction risks, so it should only be used under clinician supervision.
Some patients cannot take indomethacin because of side effects, medical risks, kidney disease, gastrointestinal risk, cardiovascular concerns, bleeding risk, or interactions with other medications. In those cases, the clinician may consider alternative medication strategies, supportive therapies, referral coordination, or evaluation of overlapping pain contributors. Treatment should be individualized.
Medication is often central to hemicrania care, especially when the diagnosis is confirmed by indomethacin response. However, supportive treatments may help selected patients manage overlapping contributors such as neck pain, TMJ tension, stress physiology, sleep disruption, chronic pain sensitization, or functional impact. These may include biofeedback, pain psychology, acupuncture, movement-based care, or carefully selected procedures when another pain generator is identified.
Seek urgent medical evaluation for a sudden worst headache, new neurological symptoms, weakness, numbness, facial droop, speech difficulty, vision loss, confusion, fainting, seizure, fever, stiff neck, head injury, cancer history, immune suppression, new headache after age 50, pregnancy with severe headache, or a major change in headache pattern.
Before care begins, our team helps patients understand the practical side of treatment, including insurance verification, out-of-network benefits, cost-share estimates, self-pay options, and billing questions. We believe patients should have as much clarity as possible before moving forward.
If you have persistent or recurring one-sided headache, especially with eye tearing, nasal congestion, eyelid changes, facial sweating, restlessness, or symptoms that have not fit clearly into migraine or cluster headache, MPM can help evaluate what may be contributing. Our diagnosis-first approach considers hemicrania continua, paroxysmal hemicrania, cluster headache, migraine, TACs, TMJ-related headache, trigeminal neuralgia, cervical pain, and other headache conditions. Request an appointment to discuss your symptoms and care options.
Hemicrania is a rare headache disorder that causes pain on one side of the head. The name refers to one-sided head pain, but clinically, hemicrania includes specific headache disorders with recognizable patterns. The two most important forms are hemicrania continua and paroxysmal hemicrania.
Hemicrania continua usually causes continuous one-sided headache lasting more than three months. The pain may fluctuate, with periods of worsening that feel more intense or disabling. Paroxysmal hemicrania causes shorter, severe one-sided attacks that may happen many times in a day.
Both conditions may include autonomic symptoms on the same side as the headache. These can include eye tearing, eye redness, nasal congestion, runny nose, eyelid swelling, facial sweating, pupil changes, eyelid drooping, or restlessness.
Hemicrania is often missed because it is rare and can resemble more common headache disorders. Patients may first be treated for migraine, sinus headache, tension headache, TMJ-related headache, dental pain, or cluster headache.
This can be frustrating for patients whose symptoms do not fully match the diagnosis they were given. A patient with hemicrania continua may have a constant one-sided headache that never fully goes away. A patient with paroxysmal hemicrania may have short, severe attacks many times per day. These patterns are different from many migraine or sinus headache patterns.
MPM evaluates the full headache history, including when symptoms began, whether the pain stays on one side, whether it is continuous or attack-based, how long attacks last, what symptoms occur with the pain, and which treatments have or have not helped.
Hemicrania continua is typically continuous. The pain remains on one side and persists for months, although intensity may rise and fall. Patients may describe a baseline headache with flares that become more severe.
Paroxysmal hemicrania is typically attack-based. Attacks are usually shorter but may be severe and frequent. Some patients experience several attacks per day. These attacks may include eye tearing, nasal congestion, eyelid changes, facial sweating, or restlessness.
Both conditions are known for a strong response to indomethacin when the diagnosis is correct. This medication response is an important diagnostic clue, but it must be considered carefully because indomethacin is not safe or appropriate for every patient.
Migraine is a neurological headache disorder that may cause throbbing pain, nausea, vomiting, light sensitivity, sound sensitivity, aura, dizziness, and functional impairment. Migraine can be one-sided, so it may sometimes be confused with hemicrania.
Hemicrania is usually strictly one-sided and may include autonomic symptoms such as eye tearing, nasal congestion, runny nose, eyelid changes, facial sweating, or restlessness. The pattern of pain, duration, frequency, and medication response helps distinguish hemicrania from migraine.
Some patients have more than one headache pattern. A person may have migraine and also have another headache disorder. This is why MPM reviews the full clinical picture rather than assuming one diagnosis explains every symptom.
Cluster headache is another severe one-sided headache disorder with autonomic symptoms. It usually causes attacks lasting 15 to 180 minutes, often around the eye, temple, or forehead. Attacks may happen in cycles over weeks or months.
Paroxysmal hemicrania can resemble cluster headache but tends to involve shorter and more frequent attacks. Hemicrania continua is different because it is continuous rather than occurring only in discrete attacks.
Because hemicrania, cluster headache, and other trigeminal autonomic cephalalgias can look similar, accurate diagnosis requires careful review of attack duration, frequency, timing, autonomic symptoms, and medication response.
Indomethacin is important in hemicrania because hemicrania continua and paroxysmal hemicrania are known for a strong response to this medication. In the right clinical context, an indomethacin trial can help support the diagnosis.
However, indomethacin is not a simple or risk-free test. It can cause gastrointestinal irritation, ulcers, bleeding risk, kidney concerns, cardiovascular risk, blood pressure issues, and medication interactions. Some patients cannot take it safely, and others cannot tolerate it.
MPM evaluates whether an indomethacin trial is appropriate based on the patient’s medical history, medication list, risk factors, prior response, and overall headache pattern. If indomethacin is not appropriate, other treatment strategies may be considered under clinician supervision.
MPM takes a diagnosis-first approach to one-sided headache. The evaluation may include a detailed headache history, neurologic symptom review, medication review, prior imaging review, and assessment of overlapping pain contributors.
The team considers whether symptoms fit hemicrania continua, paroxysmal hemicrania, cluster headache, migraine, tension headache, trigeminal neuralgia, TMJ-related headache, sinus disease, cervicogenic headache, or another condition.
MPM also evaluates whether neck pain, jaw dysfunction, facial pain, autonomic symptoms, chronic pain sensitization, sleep disruption, stress physiology, or medication overuse may be contributing to the headache pattern.
Treatment depends on the diagnosis and safety profile. When hemicrania is suspected, medication management is often central. Indomethacin may be considered when clinically appropriate, but it requires careful monitoring and is not suitable for every patient.
If indomethacin is contraindicated or poorly tolerated, the clinician may discuss other medication strategies or coordinate with neurology. Supportive care may also be helpful when patients have overlapping neck pain, jaw tension, chronic pain distress, sleep disruption, or nervous system sensitivity.
Biofeedback, pain psychology, acupuncture, and movement-based support may help selected patients manage headache-related stress physiology, flare patterns, sleep disruption, and function. These approaches do not replace headache medication or neurologic evaluation, but they may support a broader care plan.
Procedures such as trigeminal nerve block, trigger point injections, botulinum toxin, or infusion-based options should not be presented as standard hemicrania treatments for every patient. They may be considered only when the diagnosis, pain generator, and clinical pattern support them.
Not every one-sided headache is hemicrania. Severe or new headache symptoms should be evaluated carefully, especially when the pattern changes or neurological symptoms appear.
Patients should seek urgent evaluation for sudden worst headache, new weakness or numbness, facial droop, speech difficulty, vision loss, confusion, fainting, seizure, fever, stiff neck, head injury, cancer history, immune suppression, pregnancy with severe headache, new headache after age 50, or a major change in headache pattern.
MPM approaches hemicrania through a diagnosis-first, coordinated model. The goal is to identify whether the headache pattern fits hemicrania continua, paroxysmal hemicrania, migraine, cluster headache, another TAC, trigeminal neuralgia, TMJ-related headache, or another cause of one-sided head or facial pain.
For patients looking for hemicrania treatment in NYC or Manhattan, MPM offers a careful headache and pain medicine perspective focused on rare headache recognition, medication evaluation, autonomic symptom review, cervical and facial pain overlap, and coordinated treatment planning.
The goal is to clarify the diagnosis and guide appropriate next steps without overpromising outcomes.
