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Hemicrania Continua | Cure


That was unremarkable in many ways, the middle day of a working week.  To bed as normal around 12 am, eaten late and taken my last tablet of the day with dinner.  Nothing out of the ordinary lights out to wait a new day.

I share the information on this website with the single hope that my insight may provide someone, somewhere the help necessary to overcome the pain of this little known and even less understood day/nightmare.

What I describe on this page is not risk-free and I advise all to seek medical advice before attempting anything.

You should always seek professional medical advice for your own personal situation.

I was on the cusp of sleep when the pain began its ominous walk.  Alarmed, by now I was proficient at minimising pain.  Not least by increasing my dose to a fairly regular 4 tablets per day.  Maybe it was due to the late evening meal?

An hour passed by, I was pacing the house.  5, 10, 20 who cares how many minutes more,  I sat in the middle of my bed head clasped tightly between my knees. I resisted in the normal ways but the pain was ruthless and unforgiving.

Something that always provided me with minor but natural pain relief was a technique I was aware of through my experience of scuba diving. Scuba divers regularly equalise the pressure between ear, nose and sinuses while diving. This is due to the discomfort that is commonly felt in the inner ear as pressure builds while descending to greater depths.

Pressure equalisation is achieved  trying to breathe through the nose while both mouth and nose are closed.  With nowhere for the air to escape, pressure starts to build until an imbalance is equal. A light popping sensation signals successful application.

I would often try this during bouts of pain and always felt instant, gratifying but very fleeting relief. I would repeat the action countless times but would invariably give up and resign myself to indomethacin. The  fact that there was some level of relief, maybe the cause of  HC pain was somehow related?

Two hours passed, my eyes now dry with tears long spent. I welled up inside and in desperation let out a silent scream. A scream that lacked decibels was easily compensated by the sheer intensity of what I believe was engaging an enemy within. As mind and body tensed, I felt a wave of pressure building. Moments later and with a gasp, I expelled all air, slumped back on the bed and in complete submission anticipated the next round of pain.

Several seconds elapsed, (a relative eternity when tick-tock of a real clock is replaced by jab-stab of the pain clock) before I realised all but the slightest twinge of pain had retreated. Not for a fleeting second or two, my moment could be measured by a nervous smile or a comparatively infinite 1 or 2 minutes…

Had the indomethacin started to work?  My hope was soon dashed, pain crept back as brutal and unrelenting as before. Not the sequence of events I had become accustomed to but something I was determined to explore. I replayed my actions, screamed another “silent scream” but this time I meticulously observed the whole process.

A deep breath inhaled, abdominal muscles tensed, I braced as if to anticipate the extreme exertion required. Resisting the reflex action to breathe out I had unwittingly started to perform the eponymous Valsalva manoeuvre.

The Valsalva manoeuvre is a well-understood medical procedure. It is named after a 17th-century anatomist, Antonio Maria Valsalva and is defined as the action of attempting to exhale against a closed airwave. Some sports professionals routinely if not knowingly perform the Valsalva manoeuvre during physical exertion.  Indeed, many tennis players can be easily observed doing so as completion is often punctuated by a tell tale grunt or groan.

The stars were beginning to line up for me. The term can also be used to describe the action I was so familiar with, that being equalising pressure in the ears.  On this occasion, my actions were magnified tenfold. No popping of ears was experienced as I was blocking the passage of air below the mouth and nose.  The glottis, part of the larynx, was acting as a valve and the more I resisted against the natural flow of air the more the pressure built. Seconds later I released all the tension and pressure by breathing out.  Again the pain receded.

Was I actually making a difference and causing the pain to fade or was it the medication? Regardless, I continued to dispense my newfound pain relief and as incredulous as it seems I was making the difference. The time in-between my mute scream’s was growing.



Many people have emailed me asking for more details on how to perform the Valsalva manoeuvre.

Update: I have recently found a far more accurate and technical description of what actually happened on the night of my Silent Screams.

For brevity I will paraphrase, the original description can be found here.

There are two components to the recommended Anti-G Straining Maneuver (AGSM)
1.  ……etc….
2. The respiratory component is repeated at 2.5 – 3.0-second intervals. By Increasing chest pressure and expanding the lungs, increased pressure forces blood to flow from the heart to the brain.

The respiratory tract is an open breathing system which starts at the nose and mouth and ends deep in the lungs. The respiratory tract can be completely closed off at several different points. The most effective point is to close the system off at the glottis.

Closing the glottis (which is located behind the “Adam’s Apple”) yields the highest increase of chest pressure. You can find it and close it off by saying the word “Hick.” This should be said following a deep breath and forcefully (breath out) close the glottis as you say “Hick.” Bear down for 2.5 to 3.0 seconds, and then rapidly exhale by finishing the word “Hick.” This is immediately followed by the next deep inhalation repeating the cycle. The exhalation and inhalation phase should last no more than 0.5 to 1.0 second.


1. Do not hold your respiratory straining too long (more than five seconds) since this will prevent the proper returning of blood to the heart and may result in loss of consciousness.

******** Below are my original words for describing Valsalva ********

Imagine you are constipated and trying to force a bowel movement (pass a watermelon), it is the same pushing movement. As you strain and continue to push, you will feel the pressure building in your head and face.

The pushing required to give birth also results in the Valsalva manoeuvre being performed.

If you Google using these search terms “Valsalva manoeuvre labour” or “Valsalva manoeuvre constipation”  you will find many descriptions.

E.g. Purple pushing refers to holding the breath so long and with such force that the small capillaries in the cheeks and face burst. Purple pushing produces Valsalva’s Maneuver. Valsalva’s Maneuver occurs with prolonged breath-holding ~ 5 seconds whilst pushing.

It is not a risk-free action so I advise anyone to seek medical advice before attempting to perform it.



  1. babs123
    May 4, 2017

    OMG! I will definitely be trying this. Thanks very much. I will keep you updated. I am on the Gammacore trial at the moment, it’s certainly helped to an extent but as I was feeling better, decided I would try a little tipple…….NEVER again suffered for 6 days.

  2. sas
    Feb 14, 2012

    Mark, I wanted to ask you what your response was to caffeine with your hemicrania. Did you find that taking caffeine, i.e. coffee, helped reduce the pain, or could prevent the outbreak of a severe headache? Besides the breathing valsalva techinque, did anything else help?

    • mark
      Feb 14, 2012

      Sas, right from the very first headache I knew that Indomethacin worked for me. So when I did have a headache it was usually inbetween two doses when I had mistimed.

      I never tried anything else and did not notice caffine for example make any difference to my pain. The only thing that did help was the Valsalva technique to the extent that the pain has not returned for over a year.

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