although indomethacin is usually well tolerated , some patients developed gastrointestinal side effects , specially those patients who require long term therapy
. therefore , the use of cyclo - oxygenase-2 specific inhibitors could reduce secondary effects and they are essentially equipotent to indomethacin in vitro and in vivo .
indeed , some reports in the literature indicate the usefulness of the cox-2 inhibitors in the treatment of indomethacin - responsive headaches [ 38 ] .
we report four cases of hemicrania continua and a patient suffering chronic paroxysmal hemicrania completely responsive to cox-2 inhibitors .
a 42  years - old woman had sudden onset of short - lived pains on the left side of her head .
she suffers for a month an intense headache with short attacks ( about 510  min ) but high frequency ( 1018 attacks per day ) .
we put her on indomethacin 25  mg 3  times a day , and in 24  h her hemicranial pain completely disappears . because of legs oedema we discontinued indomethacin and 1  week later the pain returned .
a 56  years - old man present with an 8  month history of a continuous left - sided headache strictly unilateral .
the pain was moderate in intensity but fluctuating ( between 2 and 7/10 vas ) .
the pain exacerbations were associated with lacrimation but not phono , photofobia , nausea or vomiting .
an mri was normal and indomethacin 25  mg 3  times a day was started with completely recovery .
two - month later he started to have gastric symptoms , indomethacin was discontinued and the hemicrania return .
a 78  years - old woman with 1  year history of continuous and strictly left - sided headache , fluctuating in intensity ( 39 in vas ) and accompanied by conjuntival injection and nasal congestion during exacerbation time .
with indomethacin 50  mg 3  times a day the hemicrania disappear , however , she developed disabling subjective tinnitus 1  month later .
we discontinued indomethacin and introduced celecoxib 200  mg twice a day with completely recovery that persists 18  month later .
a 64  years - old woman with 3  years history of right - sided headache , fluctuating in intensity ( 28 in vas ) .
with indomethacin 25  mg 3  times a day the hemicrania disappear , however , the patient suffer gastrointestinal disturbances
. we discontinued indomethacin and introduced celecoxib 200  mg twice a day with completely recovery that persists 10  month later . a 76  years - old man with 6  month history of continuous left - sided headache and facial pain .
after 2  weeks on indometacina he complaint about pyrosis , that persists after omeprazol 40  mg per day .
we decided to discontinue indomethacin and introduced celecoxib 200  mg twice a day with completely recovery that persists 6  month later .
a 42  years - old woman had sudden onset of short - lived pains on the left side of her head .
she suffers for a month an intense headache with short attacks ( about 510  min ) but high frequency ( 1018 attacks per day ) .
we put her on indomethacin 25  mg 3  times a day , and in 24  h her hemicranial pain completely disappears . because of legs oedema we discontinued indomethacin and 1  week later the pain returned .
a 56  years - old man present with an 8  month history of a continuous left - sided headache strictly unilateral .
the pain was moderate in intensity but fluctuating ( between 2 and 7/10 vas ) .
the pain exacerbations were associated with lacrimation but not phono , photofobia , nausea or vomiting .
an mri was normal and indomethacin 25  mg 3  times a day was started with completely recovery .
two - month later he started to have gastric symptoms , indomethacin was discontinued and the hemicrania return .
with celecoxib 200  mg twice a day the hemicrania disappears . after 10  month
a 78  years - old woman with 1  year history of continuous and strictly left - sided headache , fluctuating in intensity ( 39 in vas ) and accompanied by conjuntival injection and nasal congestion during exacerbation time .
with indomethacin 50  mg 3  times a day the hemicrania disappear , however , she developed disabling subjective tinnitus 1  month later .
we discontinued indomethacin and introduced celecoxib 200  mg twice a day with completely recovery that persists 18  month later .
a 64  years - old woman with 3  years history of right - sided headache , fluctuating in intensity ( 28 in vas ) .
with indomethacin 25  mg 3  times a day the hemicrania disappear , however , the patient suffer gastrointestinal disturbances .
we discontinued indomethacin and introduced celecoxib 200  mg twice a day with completely recovery that persists 10  month later .
a 76  years - old man with 6  month history of continuous left - sided headache and facial pain .
after 2  weeks on indometacina he complaint about pyrosis , that persists after omeprazol 40  mg per day .
we decided to discontinue indomethacin and introduced celecoxib 200  mg twice a day with completely recovery that persists 6  month later .
we present five patients suffering indomethacin - responsive headache case 1 suffering from paroxysmal hemicranias and cases from 2 to 5 from hemicranias continua ( table  1 ) .
all of them have absolutely response to indomethacin , but the presence of adverse reactions or intolerability let us discontinued and introduce celecoxib with completely recovery of the symptoms.table  1clinical characteristics of the patientscaseagegenderheadache typesidedoses ( mg)time in month142fhpleft20012256mhcleft40010378fhcleft40018464fhcright40010576mhcleft4006all doses correspond to celecoxibf female , m male , hc hemicrania continua , hp hemicrania paroxistica clinical characteristics of the patients all doses correspond to celecoxib f female , m male , hc hemicrania continua , hp hemicrania paroxistica indomethacin is consider the first - choice drug for the treatment of  indomethacin - responsive headaches  , and the headache resolution is consider as a diagnosis criteria in some of theses headaches .
although other drugs have been reported as useful treatment , most of them are anecdotic or single cases [ 915 ] .
other anti - inflammatory drugs that have been demonstrated as alternative drugs , in particular piroxicam , however , their efficacy is lower when compared with indomethacin .
the pathophysiology of theses  indomethacin - response headache  are still unknown , but the cyclo - oxygenase ( cox)-2 should be implicated in the pathogenesis .
celecoxib have been previously reported to be effective in the treatment of other indomethacin - responsive headache [ 311 ] , however , there was no absolutely response in all patients .
anyhow , in our experience celecoxib is a good option treatment for patients suffering from hemicrania continua or chronic paroxysmal hemicranea that presents indomethacin adverse effects .
 paroxysmal hemicrania and hemicrania continua are both indomethacin - responsive headaches . 
 although indomethacin use to be well tolerated , some patients developed gastrointestinal side effects . 
 we report four cases of hemicrania continua and a patient suffering chronic paroxysmal hemicrania completely responsive to celecoxib . in our experience celecoxib 
 is a good option treatment for patients suffering from hemicrania continua or chronic paroxysmal hemicranea that presents indomethacin adverse effects . 
Introduction
Case reports
Case 1
Case 2
Case 3
Case 4
Case 5
Discussion