Causes Of Chronic Daily Headache Research Articles

Medication-Overuse Headache: Results from a Pain Medicine Clinic Cohort

Background and Objective: Medication-overuse headache (MOH) is a common, disabling, and treatable cause of chronic daily headache. This study evaluates the characteristics of a cohort of patients with MOH seen in a pain medicine clinic. Methods: We conducted a retrospective study of consecutive patients seen by a neurologist in the pain medicine clinic at the University of California, San Diego. Demographics, headache diagnoses, and overused medications were extracted from clinical records from 83 patients ≥ 18 years of age where a diagnosis of MOH was entered into the electronic medical record September 12, 2017-March 30, 2020. Results: Opioids were the most overused medications (42/83, 50.6%) followed by caffeine-containing compounds (20/83, 24.1%), triptans (12/83, 14.5%) and non-steroidal anti-inflammatory drugs (10/83, 12.9%). Chronic migraine was the most common underlying headache syndrome (54/83, 65.1%), followed by secondary headache disorder (13/83, 15.7%) and tension-type headache (8/83, 9.6%). Men were more likely to be overusing opioids (OR 3.3, p = 0.026) while women were more likely to be overusing caffeine-containing compounds (OR 5.4, p = 0.041). Discussion and Conclusions: It is crucial for pain specialists to recognize MOH in the pain clinic setting. Opioid overuse headache is more common among men, likely in part due to migraine being underrecognized in men and therefore men not receiving migraine-specific medications. Caffeine-containing compound overuse is more common among women; these are over-the-counter (OTC) and often do not appear on patients’ medications lists. Pain specialists should specifically ask patients with headache whether they are using OTC caffeine-containing compounds.

Clinical profile of chronic daily headache in patient attending tertiary centre

Background: The frequent headache syndrome is among the most challenging disorder that conforms clinician on a routine basis. A major problem with the relatively new form chronic daily headache (CDH) has been its confusion with chronic tension type headache (CTTH) and other community used term for which there have never been operational diagnosable criteria or even informal clinical criteria. The medical literature is replete with example over the past three decades in which the terms mixed headache combined headache tension headache; vascular headache and rebound headache are used interchangeably by interference. CDH became synonymous in many clinical setting with CTTH or inconvenient vascular or migrainous features or medication overuse. Now CDH is well described in literature with defined classification. Hence, the researcher is used to interested what is the burden and proportion of the various type of CDH. Aims and Objectives: Primary aim of this exploratory prospective study was to study the incidence of primary headache and secondary headache which were CDH in patient attending neurology outpatient department, to study the incidence of type of primary headache, the cause of secondary headache, the age wise distribution and sex wise attribution of CDH and to study the impact of family history, occupation and precipitating factor on CDH. Materials and Methods: In our study, a total of 626 cases fulfilling the International Headache Society-4th revised criteria comprising inclusion and exclusion criteria were included after informed consent, meticulous history taking pertaining to headache, in particular, thorough examinations and relevant laboratory investigations, and were certified by one neurologist. Results: Primary headache including migraine, tension-type headache, Short-lasting unilateral neuralgiform headache with conjunctival injection, new daily persistent headache, and medication overuse headache was the most common headache that caused CDH. Neurocysticercosis was leading cause of a secondary headache that leads to CDH. Light, fast, and stress were leading precipitants associated with CDH. Conclusion: CDH was mostly associated with primary headache over the secondary headache. Chronic migraine was leading cause of CDH in comparison to CTTH. Females were more affected both in chronic migraine and CTTH. Family history was more positive in case of chronic migraine. Vomiting nausea, photophobia, and phonophobia vertigo were leading symptoms associated with CDH whereas light, fast, and stress were leading precipitants associated with CDH.

Epidemiology and clinical characteristics of chronic daily headache in a clinic-based cohort of Iranian population

Although CDH is a major health care problem encountered in headache clinics, our knowledge about the epidemiological features of CDH is limited in developing countries. The objective of this study was to survey the frequency and clinical features of chronic daily headache (CDH) and its subtypes among Iranian population presenting to a referral tertiary Headache clinic in a University Hospital. This cross-sectional survey was carried out between September 2011 and March 2012. Data of patients with CDH including their age, sex, educational level, and marital status were recorded using structured face-to-face interview. Subtypes of the CDH were determined by history, physical examination and appropriated laboratory or imaging findings. A total number of 177 cases (32.71%) fulfilled the CDH criteria. The frequency of CDH was higher in 40-49 age groups (n = 54) and among women with a female to male ratio of 2.12/1. Chronic migraine was the most common subtype of CDH in 75 cases (44.4%). Chronic tension-type headache and secondary causes were second and third frequent subtypes of CDH in 27.8 and 20.1% of cases, respectively. Cervicogenic headaches (10.7%) and medication overuse headache (4.1%) were the most common causes of secondary headaches. The present study confirmed previous findings which showed a high prevalence of CDH and chronic migraine in clinic setting, with preponderance for women. In addition, we found the highest prevalence of cervicogenic headaches among secondary causes of CDH.

Chronic Daily Headache

Individuals presenting with chronic daily headache (CDH) are considered among the most difficult and labor-intensive patients in a neurologist's practice. However, when treated successfully, they can be the most rewarding. Successful treatment plans can be life-changing for patients. Unfortunately, due to both patient and physician-related factors, many individuals with CDH lapse from medical care and seek alternative therapies, and some continue spiraling downward, fueled by medication misuse and overuse. CDH is not a diagnosis but the presence of headache on at least 15 days/month for at least 3 months. Patients with CDH need secondary etiologies excluded through appropriate investigations before establishing treatment programs. Table 1 lists secondary causes of CDH to which the clinician must be alert. Imaging is frequently necessary to exclude secondary causes, and in the majority of cases, MRI is superior to CT because of causes that are often overlooked or not visible on head CT (table 2). In this article, we review primary CDH and discuss evidence-based treatment strategies. View this table: Table 1 Causes of primary and secondary chronic daily headache View this table: Table 2 Potential etiologies for headache that are often overlooked on head CT ### Short-duration CDH. Determining the usual duration (greater or less than 4 hours) of individual headache episodes will refine the differential diagnosis in patients with primary CDH. The prototypical short-lasting primary CDH (<4 hours) is chronic cluster headache (CCH), a trigeminal autonomic cephalalgia (TAC) characterized by severe orbital or temporal pain with accompanying cranial autonomic features such as nasal congestion or lacrimation. Cluster headache becomes chronic if attacks occur for more than 1 year with remissions lasting less than 1 month. Other TACs that may mimic CCH include chronic paroxysmal hemicrania (CPH), short-lasting unilateral neuralgiform headaches with conjunctival injection and tearing (SUNCT) syndrome, and short-lasting unilateral neuralgiform headaches with autonomic symptoms but without lacrimation and conjunctival injection (SUNA). These differ in …

New therapeutic developments in chronic migraine

Chronic migraine is a common cause of chronic daily headache, which is often refractory to standard treatment. New research has increased our understanding of this disorder and its treatment. This review focuses on recent clinical trials and advances in our understanding of migraine pathophysiology. Migraine research has traditionally focused on the more common episodic form of the disorder, but recent clinical trials have started to focus on chronic migraine or chronic daily headache. Topiramate, onabotulinum toxin type A, gabapentin, petasites and tizanidine are among the agents that appear to be effective in the treatment of chronic migraine. New acute medications including an inhaled form of dihydroergotamine will soon be available and neuromodulatory procedures such as occipital nerve stimulation may be effective for the most disabled patients. In the past few years, other studies have shed light on potential risk factors for chronic migraine such as medication-overuse headache, temporomandibular disorders, obstructive sleep apnea and obesity. This review explains advances in the treatment of chronic migraine, a common disorder seen in neurological practice. These new advances in preventive treatment and a better understanding of its risk factors will allow clinicians to better identify individuals at greatest risk and prevent the development of chronic migraine.

Botulinum Toxin Type A for Chronic Migraine

Chronic migraine (CM) is the leading cause of chronic daily headache, a common and debilitating headache syndrome. The management of CM patients is challenging, with only limited benefit from available oral preventive medications. Botulinum neurotoxin (BoNT) has been used extensively to treat disorders associated with increased muscle tone. More recent scientific data support an analgesic effect of the toxin. The pharmacokinetic and pharmacodynamic profiles of BoNT make it an appealing candidate for migraine prevention. Results from older clinical trials on the efficacy of the toxin in CM were inconclusive. However, recent trials using more stringent inclusion criteria have shown positive results, supporting the use of the toxin in some patients with this disorder. This review summarizes the scientific data on the analgesic properties of BoNT, as well as the clinical data on the efficacy of the toxin in treating CM.

Transformed Migraine: A Study of 420 Consecutive Patients from Central India

Objective: This study was carried out to analyze clinical features, transforming factors, associated co-morbidity like depression, anxiety and analgesic overuse in patients with transformed migraine. Materials and methods: This is a retrospective analysis of 420 consecutive headache patients The clinical features of headache were analyzed, like duration of headache, frequency of attacks, migraine triggers, psychological co-morbidity and analgesic use. Results: Approximately 30% patients had chronic daily headache of which transformed migraine constituted the largest group (61%). Fifty three percent patients had psychological co-morbidity. Analgesic overuse was noted in only 16% patients. Seventy five percent patients had more than one year of migraine headache. Conclusion: Transformed migraine is the most common cause of chronic daily headache. The burden of recurrent migraine attacks is the main factor in the transformation of episodic to daily migraine. doi: 10.5214/ans.0972.7531.2007.140203

Chronic Daily Headache in a Primary Care Population: Prevalence and Headache Impact Test Scores

Population-based surveys estimate the prevalence of chronic daily headache (CDH) in the general community to be approximately 4%. The prevalence of CDH among patients seen in the primary care setting in the United States, however, is unknown. To estimate the prevalence and associated burden of suffering of CDH in a primary care patient population. Cross-sectional survey of a randomly selected sample of 1500 adult patients in an academic Family Medicine Center was done. Outcome measures include self-reported headache frequency and Headache Impact Test scores. Completed questionnaires were returned by 853 (57%) patients. The mean age of respondents was 49 years (SD = 16), with a range of 18 to 94 years. Two hundred ninety-six (58%) patients reported having had 1 or more severe headaches in the past month. Seventy-four (9%) patients reported a frequency of headache consistent with CDH, defined as the occurrence of headache 15 or more days in the past month. Twenty-four patients (32%) with CDH either believed that none of their doctors know that they experienced headaches or were not sure if their doctors were aware of their headaches, and 21 (28%) reported that they have not needed a doctor's care for their headaches. The prevalence of CDH is greater among a primary care patient population compared to the general community. A substantial proportion of patients with CDH do not bring their headaches to the attention of their health-care providers. In light of the advances in the development of effective medications for migraines and the growing body of evidence implicating medications as a contributing cause of CDH, it may be appropriate to encourage patients to inform their health-care providers about their headaches and to encourage providers to identify patients with frequent headaches.

Managing chronic headaches in the clinic

To the Editor: In their recent article, Managing chronic headaches in the clinic (Int J Clin Pract 2004; 58(12):1142–51), Dowson et al. suggest that some types of headaches may not be well recognized or well treated. They discuss management algorithms, and state that ‘principles can be customized to the headache subtype by the selection of appropriate therapies’. Successful personalized treatment is a highly desirable, attainable goal that is dependent on accurate evaluation of the problem. Engineers know that the type of a problem's source predicts its appropriate type of solution: chemical problems respond best to chemical solutions, and mechanical problems respond best to mechanical solutions. Many chronic daily headache (CDH) cases have a mechanical source, and as such, cannot be treated effectively with biochemical medications. Therefore, an effective management algorithm includes the directive: obtain magnetic resonance imaging (MRI) of CDH patients to identify treatable structural causes. Case in point: since 1999, with the publication of ‘Chiari 1 malformation redefined: clinical and radiographic findings for 364 symptomatic patients’ (Neurosurgery 1999; 44(5): 1005–17), a landmark study by Milhorat et al., it has become very clear that many chronic headaches are the result of compression of the hindbrain. A volumetrically small posterior fossa crowded with a normal-sized brain restricts cerebrospinal fluid flow dynamics, as measurable by both cine MRI and colour Doppler ultrasonography (CDU). Patients with such flow restrictions and tissue compression suffer from an increased intracranial pressure, and from impaired function of affected, compressed brain parts, most notably the cerebellum, occipital lobe and brainstem. (Symptoms number into the several dozen.) Additionally, many of these patients also develop subarachnoid adhesions and abnormal cranial vasculature, and a smaller subset has tonsils that are wrapped around or tethered to the brainstem or spinal cord. Hydrocephalus is not required for the diagnosis, and, in fact, is less common than other equally symptomatic manifestations. In the US, between 200,000 and 2 million people suffer from this clearly mechanical cause of CDH. The vast majority of them are undiagnosed for months or years, and typically are misdiagnosed with migraine, tension headaches, multiple sclerosis, lupus, fibromyalgia or psychiatric disturbances. This would not happen if more primary care physicians, neurologists and pain specialists were very familiar with the devastating manifestations of mechanical hindbrain compression. The treatment for severely symptomatic posterior fossa compression is physical removal of the obstruction(s), creation of adequate space for the brain and restoration of proper CSF flow dynamics. This is accomplished surgically through the widening of the cranial–cervical junction, construction of artificial cisterna magna with attention paid to establishing a 3–5 cm/second bidirectional CSF flow at the cervicomedullary junction, and a collection volume of 8–10 cc of CSF in the new cisterna magna. The recent introduction of the intraoperative use of CDU has made this feat possible and provable. See the article ‘Tailored operative technique for Chiari type I malformation using intraoperative colour Doppler ultrasonography’ (Neurosurgery 2003; 53(4): 899–906). In addition, see http://www.thechiariinstitute.com/chiari_techniques.html. In future explorations within the realm of chronic daily headache, we hope that primary care physicians, neurologists and pain specialists will join forces with their equally dedicated counterparts in the neurosurgical world, and offer a complete picture of possible causes and matching solutions to the many headache sufferers who cross their doorsteps.

Debate: analgesic overuse is a cause, not consequence, of chronic daily headache. Analgesic overuse is a cause of chronic daily headache.

Analgesic Overuse Is A Cause of Chronic Daily Headache Stewart J. Tepper MD, Stewart J. Tepper MDSearch for more papers by this author Stewart J. Tepper MD, Stewart J. Tepper MDSearch for more papers by this author First published: 15 August 2002 https://doi.org/10.1046/j.1526-4610.2002.02133_1.xCitations: 37 Address correspondence to Dr. Stewart J. Tepper, The New England Center for Headache, 788 Long Ridge Road, Stamford, CT 06902 or Dr. David W. Dodick, Department of Neurology, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume42, Issue6June 2002Pages 543-547 RelatedInformation

CHRONIC DAILY HEADACHE

Chronic daily headache (CDH) describes a group of patients whose problem is self evident—they have a lot of headache—but whose management can be among the most challenging that neurologists face....

Effect of withdrawal of misused medication on sleep disturbances in migraine sufferers with chronic daily headache.

To evaluate the sleep pattern of migraineurs with chronic daily headache and to determine whether and to what degree it is improved by withdrawal of medication, and to reconfirm relief of headache by withdrawal of medications in migraineurs with chronic daily headache due to medication misuse. Misuse of ergotamine and analgesics by migraineurs is one of the causes of chronic daily headache. The latter is alleviated or abolished in these patients by abrupt withdrawal of the misused medication. In common with patients with chronic daily headache, migraineurs frequently complain of insomnia, usually verifiable by polysomnography. Twenty-six women with migraine, aged 18 to 49 years, with chronic daily headache due to medication misuse, voluntarily discontinued ergotamine and analgesics, and were followed at monthly intervals for 3 months. In 25 subjects, polysomnography was performed before withdrawal of medication and 3 months after withdrawal. All subjects filled out a standard sleep questionnaire on those two occasions and a daily self-assessment questionnaire focused on headaches. After 3 months, a significant decrease in mean headache frequency (P<.001) and intensity (P<.001) was demonstrated. Polysomnography performed 3 months after medication withdrawal showed significant improvement in total sleep time (P<.05), sleep efficiency (P<.05), and number of arousals (P<.001). The score of the sleep questionnaire was also significantly improved (P<.01). In migraineurs with chronic daily headache due to medication misuse, withdrawal of the misused medications alleviates the associated sleep disturbance along with diminution in frequency and intensity of chronic daily headache.

Effect of Withdrawal of Misused Medication on Sleep Disturbances in Migraine Sufferers With Chronic Daily Headache

Objectives.—To evaluate the sleep pattern of migraineurs with chronic daily headache and to determine whether and to what degree it is improved by withdrawal of medication, and to reconfirm relief of headache by withdrawal of medications in migraineurs with chronic daily headache due to medication misuse.Background.—Misuse of ergotamine and analgesics by migraineurs is one of the causes of chronic daily headache. The latter is alleviated or abolished in these patients by abrupt withdrawal of the misused medication. In common with patients with chronic daily headache, migraineurs frequently complain of insomnia, usually verifiable by polysomnography.Methods.—Twenty‐six women with migraine, aged 18 to 49 years, with chronic daily headache due to medication misuse, voluntarily discontinued ergotamine and analgesics, and were followed at monthly intervals for 3 months. In 25 subjects, polysomnography was performed before withdrawal of medication and 3 months after withdrawal. All subjects filled out a standard sleep questionnaire on those two occasions and a daily self‐assessment questionnaire focused on headaches.Results.—After 3 months, a significant decrease in mean headache frequency (P&lt;.001) and intensity (P&lt;.001) was demonstrated. Polysomnography performed 3 months after medication withdrawal showed significant improvement in total sleep time (P&lt;.05), sleep efficiency (P&lt;.05), and number of arousals (P&lt;.001). The score of the sleep questionnaire was also significantly improved (P&lt;.01).Conclusions.—In migraineurs with chronic daily headache due to medication misuse, withdrawal of the misused medications alleviates the associated sleep disturbance along with diminution in frequency and intensity of chronic daily headache.

Headache in childhood.

1. Rob Forsyth, MD* 2. Kevin Farrell, MD* 1. 2. *Division of Neurology, Department of Pediatrics, University of British Columbia; British Columbia Children’s Hospital, Vancouver, British Columbia, Canada. After completing this article, readers should be able to: 1. Describe what most parents who want help for a child who has a headache are seeking. 2. List the most common cause of severe headache in children. 3. Describe what tests must be performed prior to lumbar puncture in any patient who has a headache. 4. Determine common causes of chronic daily headache. Chronic or recurrent headache is common in children, occurring in approximately 40% of children by 7 years of age and 75% of children by 15 years. Most parents who seek help for a child who has headaches are looking for reassurance that the headache is not due to a serious cause. Pain referred to the head can arise from the following structures: 1) intracranial or extracranial arteries, large intracranial veins, or venous sinuses; 2) cranial or spinal nerves; 3) basal meninges; 4) cranial and cervical muscles; and 5) extra-cranial structures such as the nasal cavity and sinuses, teeth, mucous membranes, skin, and subcutaneous tissues. The brain, most of the meninges overlying the convexity, and the bony skull are not sensitive to pain. Pain arising from the cranial circulation and supratentorial structures travels primarily via the trigeminal nerve and is referred to the anterior part of the head. Pain arising from posterior fossa structures travels mainly via the first three cervical nerves, resulting in pain in the back of the head and neck as well as the forehead. The glossopharyngeal and vagal nerves innervate part of the posterior fossa, and pain is referred to the ear and throat. There are two major hypotheses regarding the pathogenesis of migraine. The vascular hypothesis proposes that vasoconstriction results in aura or focal neurologic signs and is followed by painful vasodilatation. The neurogenic hypothesis proposes that afferent inputs to the brainstem result in a slowly spreading …

Amitriptyline and dexamethasone combined treatment in drug-induced headache.

Frequent or regular intake of antimigraine drugs, including analgesics, constitutes a common cause of chronic daily headache. Discontinuation of symptomatic medication can produce an increase in head pain accompanied by withdrawal symptoms. We report the favourable outcome of treating a group of outpatients with the combination of amitriptyline, dexamethasone and sumatriptan. Dexamethasone (4 mg/day) was given intramuscularly for 2 weeks, amitriptyline orally at night (50 mg/day) for at least 6 months, and sumatriptan subcutaneously to treat acute headache attacks. Eighteen out of 20 patients abstained from drug abuse. Eleven of these 18 patients showed a marked reduction in headache frequency (at least 75% in relation to the basal value), and were considered "very good responders". The other seven patients experienced at least 50% reduction in headache frequency compared to baseline. This preliminary report suggests that drug-induced headache can be treated effectively in outpatients using dexamethasone, amitriptyline and sumatriptan in combination with significant benefit in everyday life conditions.

Tension-type headaches.

Tension-type headache is the term designated by the International Headache Society to describe what was previously called tension headache, muscle contraction headache, psychomyogenic headache, stress headache, ordinary headache, and psychogenic headache. The International Headache Society defines tension-type headache more precisely, distinguishes between the episodic and the chronic varieties, and divides them into two groups, those associated with a disorder of the pericranial muscles and those not associated with this type of disorder. Most clinic-based studies of tension-type headache suffer from selection bias, as they include patients with more severe headaches, patients with concomitant migraine, and patients with chronic daily headache. Traditionally, episodic tension-type headache and migraine have been considered distinct disorders, and the International Headache Society continues the separation. Some believe that both migraine and tension-type headache are recurring benign headaches. Chronic tension-type headache used to be called chronic daily headache, but they are not identical. Chronic tension-type headache must be distinguished from chronic daily headache even though the International Headache Society has not done this. Chronic daily headache is a syndrome consisting of a group of disorders and can be subclassified into primary and secondary types. The primary chronic daily headache disorders include transformed migraine, chronic tension-type headache, new daily persistent headache, and hemicrania continua. Secondary causes of chronic daily headache include post-traumatic headache, cervical spine disorders, and headache associated with vascular disorders and nonvascular intracranial disorders. Patients with frequent headaches are prone to overuse analgesics, ergotamine, or both. Most patients with chronic daily headache overuse symptomatic medication.(ABSTRACT TRUNCATED AT 250 WORDS)

Cellular Adaptation in Migraineurs with Chronic Daily Headache

Ergotamine and analgesic misuse are now recognized as causes of chronic daily headache and the condition responds well to drug withdrawal with reduced headache frequency. In this study, we have investigated whether medication misuse is associated with an alteration in membrane transduction which is sensitive to drug withdrawal. This was carried out by assay of the thrombin-stimulated generation of inositol phosphates in platelets from 12 migraine patients with chronic daily headache and analgesic misuse, 7 migraine patients with chronic daily headache and ergotamine misuse and 7 control subjects. After drug withdrawal, a significant decrease in headache frequency was seen at one month in both patient groups. Withdrawal of analgesics produced a significant decrease in thrombin-stimulated inositol phosphate production at one month; this was further decreased a month later with a reduction in Bmax of 60% and no significant change in KD. A similar pattern was obtained in ergot misuse patients, with the KD value decreasing by 56% one month after drug withdrawal. These results provide evidence of an adaptation in transduction with misuse of analgesics and ergotamine which correlates with headache frequency.