# Co-morbid Indomethacin-Responsive Headaches in a Woman in Her Late 60s With Paroxysmal Hemicrania and Hypnic Headache: A Case Report

## TL;DR

A 60s woman experienced two rare headache types that both responded to indomethacin, showing how these conditions can co-occur and be effectively treated.

## Contribution

This case report documents the rare co-occurrence of paroxysmal hemicrania and hypnic headache in one patient.

## Key findings

- Both headache types resolved completely during indomethacin treatment.
- Headaches recurred when the patient stopped taking indomethacin.
- The case highlights the challenges in diagnosing and treating these rare headache disorders.

## Abstract

Paroxysmal hemicrania (PH) and hypnic headache (HH) are rare indomethacin-responsive headache syndromes. This case report details the new onset of both disorders in a woman in her late 60s. One headache type presented as severe pain centered on the right eyebrow, lasting 30 minutes, occurring more than 8 times daily, and associated with ipsilateral lacrimation and rhinorrhea. The second type was a right frontal severe pain, with onset at 4 a.m., occurring only during sleep, lasting 30 minutes, and with no associated factors. The patient's response to indomethacin for both headache types was confirmed through an unblinded ABAB study design: complete resolution of headaches during indomethacin use and recurrence upon discontinuation. This case highlights the rarity of co-morbid indomethacin-responsive headaches and underscores the diagnostic and therapeutic challenges associated with these conditions.