Chronic Daily Headache Patients Research Articles

Effects of chronic daily headache with subclinical depression on brain volume: A systematic review and meta-analysis.

The relationship between chronic daily headache (CDH), depression symptoms, and brain volume remains unclear. To investigate the effects of CDH on brain volume and the impact of depressive symptoms (DSs) as well as the effects of demography and medication overuse, PubMed, Embase, and Web of Science databases were systematically searched using appropriate keyword strings to retrieve observational studies from inception to May 2023. Two distinct comparisons were made in CDH patients: (1) those with DSs versus their pain-free counterparts and (2) those without DSs versus pain-free controls. The first comprised nine studies enrolling 225 CDH patients with DSs and 234 controls. Beck depression inventory, Hamilton depression scale, and Hospital anxiety/depression scale were used to assess DSs, revealing significantly more DSs in CDH patients with DSs compared to their controls (all p < 0.05). Besides, the second analysed four studies involving 117 CDH patients without DSs and 155 comparators. Compared to CDH patients without DSs, those with DSs had a smaller brain volume than controls (p = 0.03). Furthermore, CDH patients with DSs who did not overuse medications showed a smaller right cerebral cortical volume than overusers (p = 0.003). A significant inverse correlation between female prevalence and brain volume (p = 0.02) was revealed using regression analysis. Pain-induced persistent depressive symptoms not only incur structural alterations but also encompass affective-motivational changes, involving medication use and gender-specific health concerns. This study highlighted the importance of an integrated CDH treatment, emphasizing psychological interventions for the affective-motivational component alongside pain management.

Association Between Iron Deficiency Anemia and Chronic Daily Headache

Background: Chronic daily headache (CDH) and iron deficiency anemia (IDA) are prevalent health issues with significant impact on individuals' quality of life. Understanding the relationship between these conditions is essential for developing effective treatment strategies. Objective: This study aims to investigate the association between iron deficiency anemia and chronic daily headache. Methods: A case-control study was conducted at Pak Emirates Military Hospital, Rawalpindi, Pakistan, from February to July 2023. The study included 140 patients diagnosed with CDH and 140 age- and sex-matched controls without a history of CDH. Demographic data (age, gender, location, education, marital status) were collected along with clinical characteristics (headache frequency, intensity, duration) and hematological parameters (hemoglobin level, serum ferritin level, red blood cell count, mean corpuscular volume, mean corpuscular hemoglobin, platelet count, white blood cell count, hematocrit level, mean corpuscular hemoglobin concentration). Statistical analysis was performed using chi-square tests and ANOVA. Results: There were no significant differences in demographic characteristics between the CDH and control groups. CDH patients exhibited higher headache frequency (57.14% experienced headaches 10-15 times per month), intensity (64.43% reported NRS score of 5-8), and duration (87.15% reported headache duration of over 4 hours) compared to controls. Hematological analysis revealed significantly lower mean hemoglobin (9.85±2.13 g/dL) and serum ferritin levels (30.72±7.65 ng/mL) in CDH patients compared to controls (13.1±2.70 g/dL and 65.09±12.82 ng/mL, respectively). A significant association between IDA and CDH was established (p&lt;0.05). Conclusion: The study demonstrates a significant association between iron deficiency anemia and chronic daily headache, highlighting the potential role of iron deficiency in the development of CDH.

Novel Use of Time-Resolved Magnetic Resonance Angiography to Evaluate Retrograde Lumbar Vein Flow and Epidural Venous Plexus Enhancement in Chronic Headache Patients With and Without Nutcracker Physiology.

Compression of the left renal vein by the superior mesenteric artery, known as nutcracker phenomenon (NCP), can cause retrograde flow and congestion in communicating venous systems. It has recently been speculated that NCP can result in retrograde flow and congestion of the lumbar veins and epidural venous plexus (EVP), thereby affecting the central nervous system. This study describes the novel use of time-resolved magnetic resonance angiography (trMRA) to evaluate for retrograde left second lumbar vein (L2LV) flow and early EVP enhancement in patients with chronic daily headache (CDH) with and without NCP. A retrospective analysis was performed of 31 patients with CDH (27 females and 4 males; median age, 38 years [range, 18-63 years]) who underwent trMRA centered over the L2LV to evaluate the direction of blood flow and presence of early EVP enhancement from May 2020 to March 2022. Descriptive statistics were performed, and anatomic associations were analyzed in patients with and without retrograde L2LV flow and early EVP enhancement. The accuracy of magnetic resonance imaging findings in detecting these flow patterns was also assessed. Patients with NCP who demonstrated narrowing of the left renal vein, a positive beak sign ( P = 0.052), decreased aortomesenteric distance ( P = 0.038), and decreased SMA angle demonstrated increased rates of retrograde L2LV flow and early EVP enhancement. A positive beak sign was 83% specific, and an aortomesenteric distance of ≤6.5 mm was 61% sensitive and 83% specific for identifying retrograde L2LV flow with early regional EVP enhancement in patients with CDH. Retrograde L2LV flow with early EVP enhancement in CDH patients can be effectively evaluated using trMRA and was seen with greater propensity in those patients with NCP.

The Efficacy of Japanese Herbal Kampo Medicine as an Acute and Prophylactic Medication to Treat Chronic Daily Headache and Medication Overuse Headache:-Single Arm Retrospective Study.

IntroductionA chronic daily headache (CDH) comprises a group of headaches occurring at least 15 days per month for three or more consecutive months. We retrospectively investigated the effectiveness of the hybrid treatment strategy for CDH using Kampo medicine combined with Western medication.MethodsWe retrospectively investigated 43 consecutive first-visit CDH patients. In addition to Western acute and prophylactic medications, we prescribed three types of Kampo medicines: goreisan, goshuyuto, and kakkonto depending on the patients’ symptoms. Headache impact test-6 (HIT-6), monthly headache days (MHD), monthly migraine days (MMD), and monthly acute medication intake days (AMD) before, 1- and 3-months after starting the hybrid medications were assessed as outcomes.ResultsThirty-six women and seven men were included. The median age was 51 years old. Nine were chronic migraine (CM), 22 were episodic migraine and tension-type headaches (EM+TTH), and 12 were chronic TTH. Twenty-seven patients also had medication overuse headaches (MOH). The medians of HIT-6 before, one and three months after treatment were 63, 48, and 40, respectively. Those of MHD were 20, 5, and 2. Those of MMD were 2, 0, and 0. Those of AMD were 15, 0, and 0. Significant reductions in HIT-6, MDH, MMD, and AMD were observed one and three months after starting Kampo treatment. Similar trends were observed in the EM+TTH and MOH patients as subgroup analyses.ConclusionThe hybrid medication strategy of Kampo and Western medicines for CDH is safe and effective in terms of both acute and prophylactic medications with rapid efficacy.

Comparison of chronic daily headache with and without medication overuse headache using ICHD II R and ICHD 3 beta criteria

Objective: To evaluate the frequency of Medication Overuse Headache (MOH) in the patients with Chronic Daily Headache (CDH) using International Classification of Headache Disorder II Revision (ICHD II R) and International Classification of Headache Disorder 3 Beta (ICHD-3 beta) criteria. We also compare the CHD patients with and without MOH using both the criteria. Patients and Methods: Consecutive CDH patients from neurology service between 2014 and 2015 were included. The patients with CDH was categorised to MOH was based on ICHDIIR and ICHD-3 beta criteria. Their demographic and headache characteristics including frequency, duration, severity and disability were noted. Severity of headache was assessed using Visual Analogue Scale (VAS). Predictors of MOH were evaluated by multivariate analysis. Demographic and headache characteristics of CDH patients without MOH were compared with those with MOH. Results: 202 patients were included whose median age was 32 (range 18–65) years, and 151(74.8%) were females. 12.3% patients fulfilled ICHDIIR criteria for MOH and 46.5% fulfilled ICHD-3 beta criteria. The predictors of MOH were female gender (OR = 3.72; 95% CI 1.72–8.02, p = 0.001), low education level (OR = 1.07, 95%CI 1.02–1.13; p = 0.007) and higher VAS score (OR = 0.67, 95%CI 0.51-0.88; p = 0.004). MOH patients as per ICHD-3 beta criteria had higher education (p = 0.02) and consumed lesser abortive drugs (p = 0.03) as compared with ICHDIIR criteria. Conclusion: The frequency of MOH increases by four-fold when using ICHD-3 beta criteria instead of ICHDIIR criteria. Females with lower education level predispose to MOH.

Comorbid Anxiety and Depression in Chronic Daily Head Ache Patients

Comorbid Anxiety and Depression in Chronic Daily Head Ache Patients

Mix headache: A valid clinical entity?

Background:Chronic daily headache (CDH) patients respond better with a combination of anti-migraine and anti-stress medications, irrespective of clinical diagnosis of chronic migraine (CM) or chronic tension-type headache (CTTH).Hypothesis:“CDH: Mix headache” type is a valid clinical entity.Materials and Methods:A total of 70 participants fulfilling the diagnosis of “primary CDH”, aged between 15 and 55 years were taken up for the present study. All these patients were subdivided into either CM or CTTH, based on the predominance of symptom profiles in these patients, in confirmation with the International Headache Society guidelines (International Classification of Headache Disorders-2, 2004). Schedules for clinical assessment in neuropsychiatry (SCAN) were applied to these patients to collect information about any mental or behavioral symptoms present at the time of the study. Psychiatric comorbidity was confirmed according to the International Classification of Diseases (ICD)-10.Results:Forty-eight (68.6%) patients could be differentiated into CM and rest 22 (31.4%) patients were given a diagnosis of CTTH. SCAN and ICD-10 diagnosis revealed the presence of comorbid anxiety and depressive illness in 47 (67.2%) patients. Thirty-four of them belonged to CM (MH) group and the rest 13 had CTTH.Discussion:We propose that these 47 (67.2%) patients of CDH form our special category of “CDH - mix headache” subtype. Thus, 14 (20%) patients constitute “CDH - migraine” subtype and rest 9 (12.8%) patients have a diagnosis of “CDH - tension headache” subtype.Conclusion:Findings of the present study validate the concept of “mix headache” and explains the clinical observation that chronic daily headache (CDH) patients responds better with a combination of anti-migraine and anti-stress medications.

The Anxious Brain in Pain: Increased Levels of Anxiety, Depression and Stress Associated with Chronic Daily Headache Patients Presenting to University-based Headache Clinic (P1.197)

The Anxious Brain in Pain: Increased Levels of Anxiety, Depression and Stress Associated with Chronic Daily Headache Patients Presenting to University-based Headache Clinic (P1.197)

Management of Chronic Daily Headache and Psychiatric Co-Morbidities by Lifestyle Modification: Participatory Action Research Combining New Communication Media.

BackgroundLifestyle modification has a significant role in chronic daily headache (CDH) management. Participatory action research (PAR) can play an important role in managing chronic medical conditions. However, it has been scarcely used in CDH management.ObjectivesThis study aimed to empower patients with CDH to modify their lifestyle in order to reduce both their headache and related psychiatric co-morbidities in a multidisciplinary headache clinic at Baqiyatallah hospital, Tehran, IR Iran.MethodsIn the PAR plan, 37 patients (27 females) diagnosed with CDH were selected using purposeful sampling. Along with face-to-face group sessions, all available communication means such as phone calls, emails, short message system (SMS), and social media (Telegram) were used to facilitate the process. Questionnaires of health promotion lifestyle profile (HPLPІІ), visual analog scale (VAS), and depression-anxiety-stress scale (DASS21) were used to collect data. The data were analyzed using SPSS software.ResultsMean age of the patients was 38.33 (± 9.7) years. Both “general pain” and “the worst imaginable pain” reduced (mean of reduction: 2.56 ± 2.7 and 2.3 ± 2.9, respectively, P < 0.001). > 50% of pain reduction occurred in “the worst imaginable pain" category (-1.45 ± 2.02, P < 0.001) and mean VAS score reduced to 5.20 (± 2.3) compared to the start of the study (7.50 ± 1.9, P < 0.001). Mean DASS-21 score also reduced significantly for depression (P < 0.016), anxiety (P < 0.026), and stress (P < 0.008). HPLPІІ score significantly improved (118.17 ± 14.8 vs. 160.83 ± 16.4, P < 0.001) and the highest increase was seen in the subscale of "stress management" (17.73 ± 2.8 vs. 25.53 ± 3.9, P < 0.001).ConclusionsThe empowering PAR plan combined with new communication tools helped the CDH patients better handle their lifestyle, reduce their headache, and lower their symptoms. Further studies with better use of currently available communication tools and social media are recommended for action research to be more applicable.

The optimization of management of chronic daily headache patients

To optimize the management of chronic daily headache (CDH) using cognitive-behavioral therapy (CBT). The study included 90 patients (76 women and 14 men), aged from 23 to 78 years (mean age 46.71±11.99) with primary forms of CDH. The patients were followed-up by the neurologist during 12 months, psychological characteristics were studied together with the psychiatrist. Patients received combined treatment, including optimized pharmacotherapy, educational program, relaxation training, CBT and exercise therapy. The diagnosis of CDH has not been previously established in 86.7% of the patients. All patients received unnecessary additional diagnostic examinations, ineffective treatment (86.7%) that resulted in the formation of wrong conceptions about their state (90%). Three months after combined treatment, a significant positive effect has been achieved in 62.2% of the patients and after 12 months in 72.2%. The combined treatment program that included CBT can relatively rapidly help patients with CDH and exerts a stable positive effect during 12 months of the follow-up.

Study of Sleep Disorders and Polysomnographic Evaluation among Primary Chronic Daily Headache Patients.

Objective:Studies related to sleep disorders and polysomnography (PSG) among chronic daily headache patients are rare. We studied this and compared chronic migraine (CM) with chronic tension-type headache.Methods:Eighty-three patients were recruited. They were evaluated by semi-structured interview, headache, and sleep diaries along with Epworth Sleepiness Scale score and insomnia symptom score. Overnight PSG was performed and data compared.Results:Chronic tension-type headache was more common than CM, both having female preponderance. Insomnia followed by excessive daytime sleepiness was prevalent sleep disorder. Sleep efficiency and Stage 3 sleep were lower in CM compared to chronic tension-type. ESSS was significantly increased among chronic tension-type patients. No significant correlation was found among PSG parameters in patients with or without sleep disorders.Conclusion:Insomnia being most common sleep disorder among chronic headache population. Chronic tension-type headache had slightly better slow-wave sleep than CM and significantly increased daytime sleepiness.

Chronic Daily Headache: Ten Steps for Primary Care Providers to Regain Control.

Chronic daily headache (CDH) affects 2% to 4% of the North American and European population. Various pathways lead to this condition, although chronification of migraine and the occurrence of central sensitization in tension headache are the 2 most common. Medication overuse headaches complicate a substantial portion of other primary headaches that have become chronic and often make their treatment more complex and less successful. A 10-step process to help primary care providers evaluate and treat CDH patients begins with excluding secondary headache disorders, then moves on to classification of the primary underlying headache disorder. Next, the exacerbating factors, as well as relevant comorbid conditions, are identified. The patient's current acute therapy is examined, and attempts are made to identify and resolve medication overuse if present. Past preventive therapies are reviewed, allowing for thoughtful design of a headache action plan with preventive, acute, and lifestyle components. Patients are asked to keep a headache diary, used to initiate a cycle of continuous improvement in a patient's response to acute and preventive therapeutic approaches. A systematic approach and partnership with patients often make it possible to convert CDH to episodic headache that is responsive to both acute and preventive therapies.

Treatment of chronic daily headache with comorbid anxiety and depression using botulinum toxin A: a prospective pilot study

Background: Psychiatric comorbidities, including depression and anxiety, are clinical entities associated with chronic daily headache (CDH). Botulinum toxin A (BTA) is a Food and Drug Administration approved drug for the treatment of chronic migraine, a subtype form of CDH. This study aimed to investigate the potential efficacy and safety of BTA for controlling psychiatric symptoms in CDH patients. Methods: A prospective, open-label, pilot study (n = 30; 7 males, 23 females) was performed. A single low-dose of BTA (40–120 U) was injected into the pericranial muscle at multiple sites. Participants were evaluated before and 1, 4, 8, 12, 16, 20 and 24 weeks after BTA treatment. Primary outcomes included: (1) headache severity, determined by a visual analog scale; (2) depression and anxiety severity, assessed via the Hamilton Depression and Anxiety Rating Scales (HAM-D and HAM-A, respectively); (3) headache frequency per month and (4) single headache episode duration. Results: Headache severity was significantly ameliorated one week after treatment. Depression and anxiety symptoms were significantly reduced one month after treatment. At month four, the headache incidence per month decreased from 28.83 ± 2.95 to 17.57 ± 11.30 d (p < 0.001), and the single headache duration decreased from 12.03 ± 9.47 to 6.63 ± 8.98 h (p < 0.001). Furthermore, the percentage of patients who required analgesics significantly decreased. BTA was well tolerated, and the adverse events were mild and transient. Conclusion: BTA treatment alleviated the severity and frequency of CDH, with improvements in depression and anxiety. These novel findings indicate that BTA may represent an effective and safe intervention to target psychiatric comorbidities in CDH.

Increased pulsatile intracranial pressure in patients with symptomatic pineal cysts and magnetic resonance imaging biomarkers indicative of central venous hypertension

BackgroundIn symptomatic individuals with non-hydrocephalic pineal cysts (PCs), it remains controversial what causes the symptoms. Based on magnetic resonance imaging (MRI) biomarkers, we proposed that PC-associated crowding of the pineal recess may cause central venous hypertension. The aim of this study was to compare pulsatile and static ICP in patients with PCs and chronic daily headache (CDH), and compare ICP data in PC patients with the previously identified MRI biomarkers. MethodsAll patients assessed with over-night ICP monitoring for PCs or CDH who had been ruled out for idiopathic intracranial hypertension without papilledema (IIHWOP) were retrieved from the database. The symptoms as well as the pulsatile and static ICP scores were compared between the PC and CDH patients, and ICP scores were compared with the MRI biomarkers indicative of central venous hypertension. ResultsThe pulsatile ICP was significantly increased in the symptomatic patients with non-hydrocephalic PCs as compared to the CDH patients. Pulsatile ICP was significantly increased in the individuals with PC-grades 3–4, who had MRI biomarkers indicative of central venous hypertension. The tectum-splenium-cyst ratio correlated positively with pulsatile ICP and an index of thalamic edema. ConclusionsPulsatile ICP is increased in symptomatic patients with PCs and imaging evidence of central venous hypertension, supporting the hypothesis that PC-induced crowding of the pineal recess and venous obstruction may cause a central venous hypertension syndrome.

Update of Inpatient Treatment for Refractory Chronic Daily Headache.

Chronic daily headache (CDH) is a group of headache disorders, in which headaches occur daily or near-daily (>15days per month) and last for more than 3months. Important CDH subtypes include chronic migraine, chronic tension-type headache, hemicrania continua, and new daily persistent headache. Other headaches with shorter durations (<4h/day) are usually not included in CDH. Common comorbidities of CDH are medication overuse headache and various psychiatric disorders, such as depression and anxiety. Indications of inpatient treatment for CDH patients include poor responses to outpatient management, need for detoxification for overuse of specific medications (particularly opioids and barbiturates), and severe psychiatric comorbidities. Inpatient treatment usually involves stopping acute pain, preventing future attacks, and detoxifying medication overuse if present. Multidisciplinary integrated care that includes medical staff from different disciplines (e.g., psychiatry, clinical psychology, and physical therapy) has been recommended. The outcomes of inpatient treatment are satisfactory in terms of decreasing headache intensity or frequency, withdrawal from medication overuse, reducing disability, and improving life quality, although long-term relapse is not uncommon. In conclusion, inpatient treatment may be useful for select patients with refractory CDH and should be incorporated in a holistic headache care program.

P044. Anger expression in chronic daily headache patients with and without psychiatric comorbidity.

Background Previous studies suggest the high prevalence of psychiatric comorbidity in chronic daily headache (CDH) patients. In particular, CDH patients showed higher frequency of anxiety and depressive disorders than episodic migraineurs [1,2]. However, negative affect emotions (like depression, anxiety and anger) influence the course and impact of headache within the normal range of affective experience, not simply when an Axis I disorder is present [3]. In the literature it is reported that individuals with headache are more likely to hold their anger-in than controls. Individuals who hold anger-in experience an increased pain severity, failure to express anger leads to more disability [4,5]. Anger levels in headache are supposed to be related to anxiety and depression [6,7], but one study showed that headache patients hold their anger-in more than controls, even after controlling for depression and anxiety [8]. The aim of this study was to investigate if anger expression levels in CDH patients are related to psychiatric comorbidity.

P027. Idiopathic intracranial hypertension without papilledema in refractory chronic daily headache.

Background A diagnosis of idiopathic intracranial hypertension without papilledema (IIHWOP) should be considered in unresponsive chronic daily headache (CDH) patients [1]. A CSF opening pressure (OP) above 200 mm H2O has been detected in chronic migraine patients with conflicting result, ranging from 10% to 86% of patients [1,2]. Moreover, controversies exist regarding the OP cut-off value greater than 200 or 250 mm H2O and the role of transverse sinus stenosis (TSS) [3,4].

Features of chronic daily headache: a clinical analysis of 128 cases

Objective To review the clinical features of chronic daily headache (CDH). Methods The clinical data of 128 patients with chronic daily headache, including general condition, characteristics of headache, concomitant symptom and disability were analyzed retrospectively. The features of primary chronic daily headache (PCDH) and medication over-dose headache (MOH) were compared. Results Among 128 cases females accounted for 79.7% with an average age of 45.2 years and 88 patients were associated with drug overdose. The symptoms included nausea(68/128), photophobia(75/128), phonophobia(102/128), depression(77/128)and irritability(93/128), sleep disorders(94/128), dizziness(75/128), emotional irritability(58/128) and depression(21/128). The migraine disability assessment questionnaire and headache impact test-6 scores showed that disability was resulted from the severe degree of headache in 62.2%(51/82) and 73.2%(82/112) of CDH patients respectively. Compared with PCDH patients, the MOH patients had older age(t=2.59, P=0.011), longer duration(t=2.48, P=0.015) and severer degree of headache(t=5.58, P=0.018), and chronic migraine (t=11.95.P=0.001) was the most common primary headache type. Conclusions Most CDH patients are middle-aged women, with moderate to severe pain, usually complicated with depression, dysphoria and asomnia. Chronic daily headache patients are commonly associated with drug overdose. Key words: Headache disorders; Signs and symptoms; Retrospective studies

A Multicenter, Double-Blind, Randomized, Placebo-Controlled Trial to Evaluate the Efficacy and Safety of Duliang Soft Capsule in Patients with Chronic Daily Headache.

Objective. To investigate the efficacy and safety of traditional Chinese medicine Duliang soft capsule (DSC) in prophylactic treatment for patients with chronic daily headache (CDH). Methods. A multicenter, double-blind, randomized, placebo-controlled clinical study was conducted at 18 Chinese clinical centers. The participants received either DSC or placebo for 4 weeks. The primary efficacy measure was headache-free rate (HFR) in a 4-week period between the pretreatment and posttreatment stages. The secondary efficacy measures were the decrease of headache days, the duration of headache attacks, the frequency of analgesic usage, quality of life, disability, and the headache severity (VAS scores). The accompanying symptoms and adverse events were also assessed. Results. Of 584 CDH patients assessed, 468 eligible patients were randomized. 338 patients received DSC, while 111 patients were assigned in the placebo group. Following treatment, there was a 16.56% difference in HFR favoring DSC over placebo (P < 0.01). Significant differences were also observed between DSC and placebo groups in the secondary measures. However, no statistical difference was found between the two groups in the associated symptoms. No severe adverse effects were observed in the study. Conclusions. DSC might be an effective and well-tolerated option for the prophylactic treatment of patients with CDH.

EHMTI-0088. Prediction of treatment response in chronic daily headache patients (a prospective study)

The prevalence of chronic daily headache (CDH) is 4-5% in general population. In headache clinics about 40% patients have CDH and 50-82% of them overuse acute drugs. Combining pharmacological and behavioural therapies can increase effectiveness of treatment, but predictive factors of treatment response are still discussed.