In patients with indomethacin-responsive hemicrania continua, what are the optimal strategies for long-term dosing of indomethacin to maintain symptom control and minimize adverse effects?  

It's a very difficult question. The usual practice is to first establish a diagnosis (if it's truly an indomethacin-responsive headache). Once established, try to decrease the dose to the most tolerable. Many physicians, including our headache program, continue indomethacin for up to a maximum of 2 ...

I do consider the long-term use of indomethacin for whatever indication an issue because of potential gastrotoxicity and nephrotoxicity. The potential gastrotoxicity I addressed by combining the indomethacin with a proton-pump inhibitor (PPI) and checking the blood every 1/2 year for a decrease in h...

Agree with Dr. @Qaiser. Many patients with a true indomethacin-responsive headache will become headache-free if sufficient initial dosing is used (i.e., up to 75 mg TID). I will then decrease the dose to 25 mg QD-BID with prn dosing allowed, and monitor. If they remain headache-free, I will do a tri...