Herpes zoster ophthalmicus evolving into headache characterised as hemicrania continua

Postherpetic neuralgia (PHN) is the most common chronic complication of herpes zoster infection. However, a few patients may develop different types of pain after herpetic lesions. We are reporting two patients who developed postherpetic hemicrania continua (HC). Case 1: a 54-year-old woman had a 10-month history of continuous left-sided pain with superimposed exacerbations. The pain started with the onset of herpetic lesions in the ophthalmic division. The lesions subsided in a few weeks. However, the pain persisted and it responded exclusively to indomethacin. Case 2: a 61-year-old woman developed clinical features pertinent to PHN. However, later on, the pattern and associated clinical features changed. The patient fulfilled the criteria of HC and showed a complete response to indomethacin. We suggest that every patient with PHN should be asked for cranial autonomic features and a trial of indomethacin should be given in refractory herpes zoster neuropathy.

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