Management Of Chronic Daily Headache Research Articles

Management of Chronic Daily Headache with Focus on Botulinum Toxin Type A

Aim: The purpose of the study was to review the efficacy, safety, and tolerability of botulinum toxin A (BTX-A) as a prophylactic treatment in adults with chronic daily headache (CDH). Material and methods: The research participated in 100 patients with CDH comparing two groups of patients. Group I, 54 patients (31 women and 23 men) treated by BTX-A and group II, 46 patients (27 women and 21 men) treated with the classical method, with an average age of 35 ± 9 years. The patient’s condition in group I was assessed on the third day, on the 7th day and the 15th day after the BTX-A injection and assessed every 15 days for 3 months, in group II the patients were evaluated every 15 days. Results: After 3 months headache severity in group I: 2 (3,7%) patients had no changes, 7 (12,9%) patients with less than 50 percent reduction in pain, 23 (42,6%) reported 70 to 95 percent pain relief, and 22 (40,8%) had complete relief. Group II: 12 (26,1%) patients had no changes, 16 (34,8%) patients with less than 50 percent reduction in pain, 10 (21,7%) reported 70 to 95 percent pain relief, and 8 (17,4%) had complete relief. The mean change from baseline frequency of headaches ranged from 3 ± 1 headaches per 30‐day periods in-group I and 7 ± 2 headaches in group II. The patient’s in-group I used painkillers for an acute headache 4 ± 1 day, compared to 10 ± 2 days for the group II per 30-day period. Conclusion: In this study, BTX-A injections are safe, well-tolerated, not any treatment-related serious adverse events reported. BTX-A injections recommended optimizing clinical outcomes for patients with CDH without using other prophylactic medications. Although, further observations are needed.

Current perspectives on the development and treatment of chronic daily headache in children and adolescents.

Headache disorders subsumed under the term chronic daily headache (CDH), including chronic migraine, chronic tension-type headache and new daily persistent headache, affect up to 4% of the pediatric population and can be highly disabling and challenging to effectively treat. Although historically the knowledge base about this group of headache disorders in children primarily was derived from clinical observation and extrapolation from adult studies, over the past several years there have been important research findings relevant to the development and management of pediatric CDH that can help inform clinical practice. The intent of this paper is to provide a focused review on recent empirical work done on pediatric CDH and suggest avenues for future work.

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.

Elevated blood pressure and analgesic overuse in chronic daily headache: an outpatient clinic-based study from China.

BackgroundMany studies have reported that hypertension is common in chronic daily headache (CDH) and its subtype chronic migraine (CM), but the reason is still poorly understood. Our clinical literature review suggested that analgesic overuse may be associated with elevated blood pressure (BP), so we performed the present study to investigate the frequency of elevated BP and its link with analgesic overuse in CDH and its subtypes.MethodsA cross-sectional study was conducted in neurology outpatients with a diagnosis of CDH according to International Headache Society criteria. CDH patients were classified into CM and non-CM groups, and subclassified with or without analgesic overuse.ResultsElevated BP was present in 27.96% of CDH patients. Compared with non-CM patients, patients with CM had a longer duration of headache and more severe pain intensity, and a family history of headache and analgesic overuse were also more common, but the elevated BP frequency was not different between the two groups. Almost one-third of the patients had analgesic overuse; 96.8% of which comprised acetaminophen-containing agents. Those with analgesic overuse had a higher frequency of headache than those without analgesic overuse in both the CM and non-CM groups.ConclusionsAlthough the CM patients had a longer duration of headache, more severe intensity, the frequency of elevated BP wasn’t higher than non-CM group. Analgesic overuses maybe the reason of higher frequency of elevated BP in CDH and its subtypes. This may have predictive value for clinicians to improve CDH management.

Management of chronic daily headache in children

Children and adolescents can develop frequent, at times daily, headaches. The more severe forms of headaches that these children experience are often migrainous. This article discusses the typical characteristics of these patients and reviews treatments considered in this condition. Unfortunately, there are no high-quality studies to definitively guide treatment in children with chronic daily headache. Treatment decisions are often made using data from adult studies, childhood studies on episodic migraine or expert opinion. Current data on which to base treatment decisions are reviewed in this article.

Diagnosis and Management of Chronic Daily Headache

Chronic daily headache (CDH) is a descriptive term that encompasses multiple headache diagnoses and affects approximately 4% of the general adult population. Chronic daily headache results in significant pain and suffering with substantial impact on quality of life, and enormous economic costs to society. Although most patients with primary CDH suffer from chronic migraine or chronic tension-type headache, other primary and secondary headache disorders can also manifest as a CDH syndrome. For CDH management to succeed, secondary headaches need to be ruled out with proper investigations when judged necessary. If the diagnosis of primary CDH is established, diagnosis of the specific CDH subtype is imperative to institute appropriate treatment. The diagnosis and management of distinct CDH entities, chronic migraine, chronic tension-type headache, new daily persistent headache, and hemicrania continua, are the primary forms of CDH and the emphasis of this review. Although, strictly speaking, medication overuse headache is a secondary form of CDH, it is also highlighted in this review given its frequent association with primary CDH.

The Effect of Single-Dose Propofol Injection on Pain and Quality of Life in Chronic Daily Headache: A Randomized, Double-Blind, Controlled Trial

On the basis of a small number of case studies, IV propofol has been advocated for the treatment of chronic daily headache (CDH). There has been no randomized controlled trial of this therapy. Our objective in this randomized, double-blind, placebo-controlled trial was to determine whether a single IV dose of propofol 2.4 mg/kg results in clinically significant reduction in disability or pain in CDH for the next 30 days. Eligible adults with CDH received either active treatment with IV propofol infusion (n = 20) or active placebo of IV midazolam (n = 20). The main outcome measures were (a) Headache Disability Inventory (HDI) at 30 days posttreatment, (b) Headache Index, a summary measure of headache intensity over the 30-day period, and (c) analgesic consumption measured as the Medication Quantification Scale version III. Propofol reduced the HDI by 9.47 points (sd 14.1) at 30 days after injection (P = 0.009), but this is a smaller reduction in headache-related disability than that which the developers of the HDI regard as clinically significant. There was no statistically significant change in HDI for the control group. There were no significant within- or between-group reductions in mean pain intensity as measured by the Headache Index or medication use as measured by the Medication Quantification Scale version III in either group. A single IV infusion of propofol 2.4 mg/kg produces a statistically significant, but not clinically meaningful, reduction in disability from CDH 30 days after infusion and does not reduce pain intensity or analgesic use. This study does not support this regimen of IV propofol for clinical management of CDH.

Migraine and chronic daily headache management: implications for primary care practitioners

The aim of this paper is to outline the classifications of migraine and chronic daily headaches (i.e. headaches occurring at more than 15 days per month) and briefly describe their epidemiology and management. After outlining the patients' management behaviours, this review paper discuss the implications for primary care practitioners, including general practitioners and nurses. Finally the paper sets out current resources for headache education for healthcare practitioners. There is a scarcity of recent literature about migraine and chronic daily headache in primary care and of the evidence base for best practice. Patients with migraine and headache may see a variety of healthcare professionals and may not always be accessing the best sources of help. Various databases were searched, such as CINAHL, Cochrane, Medline, MedlinePubmed and the BMJ. In addition, manual searches were conducted by following on cited references from papers read. The results of the literature reviews were critically read and evaluated by the team and the results are discussed in the critical review presented in this paper. The paper proposes multidisciplinary working in relation to migraine and headache management in primary healthcare, using an evidence-based approach that stresses the importance of making the correct diagnosis, patient focused management and appropriate referrals to appropriate agencies to maximize benefits for patients.

Medication Overuse Worsens Chronic Daily Headache

Source: Wiendels NJ, van der Geest MCM, Neven AK, et al. Chronic daily headache in children and adolescents. Headache. 2005;45:678–683. A retrospective review of medical records of 79 children and adolescents younger than age 16 years with headache more than 15 days a month is reported from Leiden University Medical Center, the Netherlands. Chronic daily headache (CDH) occurred in 57 (72%) patients for more than 6 months. Headache duration was more than 4 hours a day in 60% of the cases. Analgesics were used by 60 children (76%), with daily use in 13 (16%). Frequent school absenteeism and sleeping problems were reported in one-third of patients. Twenty-eight patients (35%) could be classified according to the International Headache Criteria: 17 (22%) had chronic tension-type headaches, 5 (6%) had chronic migraine, 6 (8%) had medication overuse headache, 15 (19%) did not fit any category, and 36 (46%) presented insufficient data for classification. Withdrawal of all analgesic medication is recommended in CDH management.Dr. Millichap has disclosed no financial relationships relevant to this commentary.CDH is defined as primary headaches occurring 15 or more days a month and lasting more than 4 hours a day. The International Classification of Headache Disorders (ICDH-II) for Adults includes 4 types of CDH, each with or without medication overuse: chronic migraine, chronic tension-type headache, new daily persistent headache, and hemicrania continua.1 CDH may evolve over time, beginning as episodic migraine or tension-type headache and becoming chronic and persistent. Secondary headache disorders, such as post-traumatic headache, are excluded. No specific pediatric CDH criteria have been developed, but the recent increased recognition and interest in this health problem has prompted recommendations by the Pediatric Committee of the American Association for the Study of Headache.2 Areas of interest include: CDH prevalence in children (estimated at 0.9% in children compared to 4% in adults); a uniform definition specific for pediatric CDH; psychological profiles and interventions; and treatment strategies other than medication. Headache severity in children is dependent on coping characteristics, functional disability indicators such as missed school days and sleep disorders, and disrupted peer and social activities. Adolescents with CDH often state that the pain is severe while having symptoms of la belle indifference. A history of school phobias and family problems is common.In adults, CDH commonly is associated with medication overuse,3 and in children in the above study, 16% used analgesics daily. Analgesic overuse for migraine or tension-type headache may cause rebound headache and is a significant risk factor for CDH development, sometimes delayed in onset. 4 Medication overuse headache is probably more prevalent in the older adolescent, leading to the recommendation of withdrawal of all medication in CDH treatment. A general, practical approach to pediatric CDH management includes: discontinuance of analgesics and caffeine; adequate sleep; elimination of tyramine-containing cheese, caffeine-containing beverages, and other headache triggers from the diet;5 no skipped meals; daily exercise; biofeedback; and psychological intervention.6If ever there were a need to repeat this type of study prospectively using a headache diary rather than a medical record alone, this retrospective study is it. Until then, an empirical trial of removal of analgesic medication still seems like something we should be aching to try on our patients with CDH.

CHRONIC DAILY HEADACHE

Objective: Chronic primary daily headache is more common than originally thought. It does not appear to be a singular disorder but rather one with various subtypes, including chronic migraine (evolved migraine or transformed migraine), chronic tension‐type headache, newly defined daily persistent headache, hemicrania continua, and posttraumatic headache. These subtypes and their mangement are the focus of this review. Summary: The management of chronic daily headache is difficult and complex. Those affected have a sensitive nervous system, which the author believes is an inherited predisposition. Under appropriate conditions, the equilibrium or balance between bombardment from painful stimuli and the regulatory systems that inhibit those stimuli is disrupted, allowing painful stimuli to become manifest at a greater intensity than in the nonmigraineur. Successful management depends on close adherence to nonpharmacologic approaches and phamacologic regimens that desensitize the system and restore equilibrium. Comorbid conditions must be idetnified and treated as well. Comment: Dr. Gary Ruoff has a very large headache practice, and has been thinking about the clinical issues of CDH for many years. He is also an original thinker and fastidious clinical researcher, so when he writes, I always find it illuminating. He is in the process of completing a large study on CDH, migraine, and comorbidity from his family practice, and this article is the first of what I hope will be many from that project.—Stewart J. Tepper, MD

Management of Chronic Daily Headache: Challenges in Clinical Practice

Chronic daily headache (CHD) refers to a category of headache disorders that are characterized by headaches occurring on more than 15 days per month. This category is subdivided into long- and short-duration (>4 or <4 hours) CDH disorders based on the duration of individual headache attacks. Examples of long-duration CDH include transformed migraine (TM), chronic migraine (CM), new daily persistent headache (NDPH), acute medication overuse headache, and hemicrania continua (HC). The goal of this review is to enable clinicians to accurately diagnose and effectively manage patients with long-duration CDH. Patients with CDH often require an aggressive and comprehensive treatment approach that includes a combination of acute and preventive medications, as well as nondrug therapies.

Migraine and chronic daily headache management: a qualitative study of patients' perceptions.

The aim of the study was to gain insight into the patients' perceptions of migraine and chronic daily headache (CDH) management. Thirteen, semi-structured and individual interviews with seven migraine and five CDH patients were carried out and analysed in QSR NUD*IST5, using a grounded theory methodology. The participants described using five areas of management: 1) health care use; 2) medication use; 3) alternative therapies; 4) social support; and 5) lifestyle and self-help. The participants described their expectations, preferences, worries and (dis)satisfaction in relation to these five areas of management. The participants adapted headache management to suit their needs and preferences, making migraine and CDH management highly individual and giving the headache patient a central role within their own care. Health care is changing towards a greater involvement of the patients in their own care. Therefore, it is important to increase understanding of the patients' perspective of chronic diseases, including migraine and CDH. The results from this study inform health care professionals of the range of their patients' needs and preferences. This knowledge can be used to shape clinical practice, to develop patient education programmes and to further research efforts into issues that are important to the headache patient.

MIGRAINE TREATMENT

The objective of this study was to gain insight into the patients' decision‐making for migraine and chronic daily headache management. Patients were recruited by theoretical sampling in Surrey (UK). Semi‐structured and tape‐recorded interviews (n = 13) were conducted, transcribed verbatim, coded and analysed according to the grounded theory methodology. Thirteen patients (8 migraine and 5 chronic daily headache) described their management. All patients employed multiple behaviours to manage their headaches. From the patients' descriptions emerged their decision‐making. Based on experience, perceptions and new information, the decision‐making process involved four stages: headache severity, evaluation, decision making and behaviours. Although the participants were passive with regards to certain management strategies, overall they were actively involved in treating and preventing their headaches. Furthermore, they were active decision‐makers in choosing appropriate management. Migraine and chronic daily headache patients are actively involved in managing their headaches. They are key decision‐makers and should not be overlooked as a resource for effective management. Comment: Dr. Dowson and colleagues have been interested in how to deliver better headache care to large numbers of patients in primary care. This study reviews how patients decide on treatment, which is crucial for us to understand as practitioners. SJT

Patients' decision-making for migraine and chronic daily headache management. A qualitative study.

The objective of this study was to gain insight into the patients' decision-making for migraine and chronic daily headache management. Patients were recruited by theoretical sampling in Surrey (UK). Semi-structured and tape-recorded interviews (n = 13) were conducted, transcribed verbatim, coded and analysed according to the grounded theory methodology. Thirteen patients (8 migraine and 5 chronic daily headache) described their management. All patients employed multiple behaviours to manage their headaches. From the patients' descriptions emerged their decision-making. Based on experience, perceptions and new information, the decision-making process involved four stages: headache severity, evaluation, decision making and behaviours. Although the participants were passive with regards to certain management strategies, overall they were actively involved in treating and preventing their headaches. Furthermore, they were active decision-makers in choosing appropriate management. Migraine and chronic daily headache patients are actively involved in managing their headaches. They are key decision-makers and should not be overlooked as a resource for effective management.

Opioid resistance in chronic daily headache: a synthesis of ideas from the bench and bedside.

Chronic daily headache is a complex pain disorder that encompasses many diagnostic and therapeutic challenges. Our understanding of the pathophysiologic processes of intermittent migraine has improved over the past decade, but the biologic basis of chronic daily headache remains obscure. Some of the more common issues confounding management of patients who experience chronic daily headache are medication overuse, psychiatric comorbidity, refractoriness to pharmacologic treatments, and disability. Long-acting opioid analgesics would appear to provide a viable treatment option for those patients who remain refractory to other treatment interventions; however, clinical experience often does not support this belief. Current concepts of the pathophysiologic basis of chronic pain and associated neural plasticity may elucidate a biologic basis for the general inefficacy of opioids in the management of chronic daily headache. This article explores the models of pathophysiology for migraine and chronic daily headache, the concept of chronic daily headache as a neuropathic pain syndrome, neural plasticity in the context of neuropathic pain states, the physiologic basis for opioid tolerance and opioid-induced hyperalgesia, and how each of these conditions interact to provoke the general lack of opioid efficacy often observed in the management of chronic daily headache.

Cognitive-behavioral issues in the treatment and management of chronic daily headache.

Chronic daily headache is a heterogeneous group of daily or near-daily headaches that afflicts close to 5% of the general population and accounts for close to 35% to 40% of patients at headache centers. First-line drug or cognitive-behavioral therapies administered alone have minimal impact on reducing the frequency or severity of headaches. However, combined drug and cognitive-behavioral therapy shows promise in providing the most benefit for this often intractable condition. Cognitive-behavioral therapies focus on preventing mild pain from becoming disabling pain, improving headache-related disability, affective distress, and quality of life, and reducing overreliance on medication. For cognitive-behavioral therapies to be effective, it is important to address complicating factors, including medication overuse, psychiatric comorbidity, stress and poor coping, and sleep disturbance.

Chronic daily headache in children and adolescents.

Chronic daily headache (CDH), an almost continual headache in the absence of organic pathology, is an exceptionally challenging type of headache to treat in children and adolescents. CDH has different expressions in children and adults; the different expressions may reflect several different etiologies or a developmental continuum. Although a positive family history predisposes children to develop headache, many environmental, biological, and psychological processes may share a role in the etiology. To date, no studies have examined the pathophysiology of CDH in children so that our understanding is presumed, rather than documented, and based primarily on extrapolation from adult studies. For some cases with migraine features, presumed mechanisms include a neurogenic inflammatory cascade, vascular reactivity, and serotonin, whereas for other cases, mechanisms may include pericranial muscle tenderness or musculoskeletal abnormalities, as noted recently for adults. A skilled and careful history is the first step to ensuring an accurate diagnosis for children with CDH. Pain assessment is an integral component of diagnosis and treatment. We need an objective measure of headache activity and an understanding of the factors that cause or exacerbate headaches for an individual child. Although many drug and nondrug therapies are available for treating children's headache, we lack data about which therapies are best for children with CDH or its subtypes. The current principles guiding our management of CDH in children and adolescents are extrapolated from the existing literature on childhood headache, CDH in adults, and our clinical experience. A child-centered focus is particularly important in the treatment of CDH because it is not caused by an underlying disease or disorder.