Primary Chronic Daily Headache Research Articles

The efficacy of repetitive transcranial magnetic stimulation in treating patients with chronic daily headache

BackgroundHeadache is the most common pain disorder, affecting around 66% of the global population. This study aimed to investigate the efficacy of high-frequency repetitive transcranial magnetic stimulation (rTMS) in treating patients with primary chronic daily headaches (chronic tension-type headache and chronic migraine).MethodsTwenty-seven patients participated in the study, divided into 2 groups: a study group (16 patients) and a control group (11 patients). Treatment consisted of 12 high-frequency (5 Hz) real rTMS sessions, delivered over the left dorsolateral prefrontal cortex (DLPFC), whereas sham rTMS was used for the control group.ResultsPatients of the study group, after real rTMS stimulation, showed a high statistically significant reduction of the measured headache parameters compared to the control group (P value < 0.001), and the percentage of improvement was 94.5%. No significant reduction of headache parameters, after sham rTMS stimulation, was observed in the control group (P value > 0.05) and the percentage of improvement was 7.9%.ConclusionHigh-frequency rTMS is effective in reducing chronic tension headaches and chronic migraines. This finding runs with the approval of the suggested role of DLPFC in pain control. This might open opinions for new treatment strategies in tension-type headache and migraine prevention.

Validity and Reliability of the Fibromyalgia Rapid Screening Tool Among Individuals with Chronic Daily Headache: A Clinic-Based Study.

Fibromyalgia is a common chronic pain disorder typically associated with headache disorders, particularly chronic daily headache. However, fibromyalgia is typically underdiagnosed and undertreated. The Fibromyalgia Rapid Screening Tool questionnaire is a brief, self-administered questionnaire composed of six "yes/no" questions for detecting fibromyalgia. The Fibromyalgia Rapid Screening Tool questionnaire has demonstrated high sensitivity and specificity among patients with chronic diffuse pain conditions. This study assessed the validity and reliability of the aforementioned questionnaire for detecting fibromyalgia among patients with chronic daily headache. Consecutive first-visit headache patients with primary chronic daily headache (≥15 days/month for three or more months) at the outpatient clinics of four university hospitals were enrolled in this study from April 2015 to October 2015, and the validity and reliability of the Fibromyalgia Rapid Screening Tool questionnaire for determining fibromyalgia were evaluated. Fibromyalgia was diagnosed according to the American College of Rheumatology criteria of 2010. A total of 171 patients with primary chronic daily headache were recruited, and 100 (58.4%) were determined to have fibromyalgia. Receiver operating characteristic curve analysis revealed that a cutoff score of 5 (corresponding to the number of positive items) provided the highest rate of correct identification of patients (77.2%), with a sensitivity of 70.0% and specificity of 87.3%. The positive and negative predictive values were 88.6% and 67.4%, respectively. The Cronbach's alpha coefficient was 0.684. The Fibromyalgia Rapid Screening Tool is a valid and reliable instrument for identifying fibromyalgia among patients with chronic daily headache.

A Study of Type of Chronic Daily Headache in Tertiary Care Population: A Hospital Based Study

Background: Chronic daily headache (CDH) is a broad term which includes groups of headache disorders and it is not a diagnosis. Primary and secondary chronic daily headache are the two common types of headaches. We planned the present study to assess and evaluate Chronic Daily Headache & its subtype’s distribution according to age & sex. Materials & Methods: The present study included assessment of pattern of Chronic Daily Headache in Tertiary Care Population. Consecutive patients with chronic daily headache (CDH) attending the neurology and medicine Out Patient Department were enrolled for the study. Here chronic daily headache refers to a group of disorders. So we could not define it but it characterizes by very frequent headache each around for 4 hours (≥15 days a month) including headache associated with medication overuse. CDH group include various primary and secondary headaches. All the results were recorded on excel sheet and analyzed by SPSS software. Results: A total 200 patients with Chronic Daily Headache have been studied. The maximum number of the patients (65%) was seen in the age group of 21-40 years. No patients were seen in 61-65 years. All 78 patients with Medication overuse Headache had either Chronic Migraine or Chronic Tension Type Headache. Mean age of CM patients was lower as compared to mean age of Chronic Tension Type Headache (CTTH) patients, this difference was statistically significant. Conclusion: Chronic daily headache frequency & its sub type CM & CTTH are higher in females as compared to males. Female to male ratio is higher in Chronic Migraine (CM) (5.3:1) as compared to CTTH (1.9:1).

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.

O206 The efficacy of repetitive transcranial magnetic stimulation in treating patients with chronic daily headache

Objectives Headache is the most prevalent pain disorder, affecting around 66% of the global population. This study aimed to investigate the efficacy of high-frequency repetitive transcranial magnetic stimulation (rTMS) over the left DLPFC in treating patients with primary chronic daily headaches (chronic tension type headache and chronic migraine). Methods Twenty-seven patients participated in the study, divided into two groups: a study group (sixteen patients) and a control group (eleven patients). Treatment consisted of twelve high frequency (5 Hz) real rTMS sessions, delivered over the left DLPFC, every other day excluding weekends, whereas sham rTMS was used for the control group. Measures of attack frequency, headache intensity and headache index were recorded before and after treatment. Results Patients of the study group, after real rTMS stimulation, showed a high statistically significant reduction of the measured headache parameters compared to the control group (P-value 0.05) and percentage of improvement was 7.9%. Discussion Results came in agreement with most of other studies done in this field. Conclusion High-frequency rTMS is effective in reducing chronic tension headache and chronic migraine. Significance This finding runs with the approval of the suggested role of DLPFC in pain control. This might open opinions for new treatment strategies in tension type headache and migraine prevention.

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.

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

Operational diagnostic criteria for chronic migraine: expert opinion.

The prevalence, disability, progression, and treatment needs associated with chronic migraine (CM) mandate epidemiological, clinical, and basic research to better understand the clinical course of this disorder and to facilitate development of more effective therapies. Such efforts have been significantly impeded by lack of agreement within the headache specialist community of the most appropriate diagnostic criteria for CM. This paper reviews the pertinent nosological literature and extensive field testing already performed. We recommend that the International Classification of Headache Disorders-3β criteria for CM be modified. We would remove the need for 5 prior migraine attacks and would replace "Headache considered by patient to be onset migraine and relieved by a triptan or an ergotamine derivative" with "criteria A and B for 1.5 probable migraine." The proposed criteria are guided by the aims of accurately characterizing patients with migraine who develop primary chronic daily headache, reflecting the large numbers of patients with CM in clinical practice, and facilitating research into a disorder that is an academic and clinical priority.

Medication Overuse Headache: A Trap for the Headache Patients

Medication Overuse Headache (MOH) was previously termed analgesic rebound headache, drug-induced headache, and medication-misuse headache. It is not a primary headache but frequently coexists with primary chronic daily headache. All acute symptomatic medications used to treat headaches have the potential for causing MOH. Highest with opioids, butalbital-containing combination analgesics, and aspirin/ acetaminophen/caffeine combinations. The development is typically preceded by an episodic headache disorder, usually migraine or tension-type headache, that has been treated with frequent and excessive amounts of acute symptomatic medications. The diagnosis is based upon clinical impression. A history of analgesic use averaging more than two to three days per week in association with chronic daily headache is suggestive. The diagnosis is made when the pattern of frequent headaches fulfills the diagnostic criteria for MOH. The basic steps in the management: Patient education, withdrawal of the offending medication, bridge (transitional) therapy, establishment of a headache treatment regimen covering acute and preventive care, follow up and relapse prevention. Birdem Med J 2013; 3(2): 94-98 DOI: http://dx.doi.org/10.3329/birdem.v3i2.17213

Impact of socio-demographic factors on quality of life of primary chronic daily headache patients

Primary chronic daily headaches (CDHs) have a considerable negative impact on patients. It leads to poor quality of life (QOL) and diminished ability to function in day-to-day life, in spite of this sufficient work has not been done in this area in India. The purpose of this study was to determine influence of sociodemographic variables on QOL of primary daily headache patients. A prospective study was carried out on 50 consecutive primary CDH patients attending psychiatry and neurology outpatient unit, diagnosed as per IHC 2003 criteria. They were evaluated using a specially designed proforma and QOL was evaluated using the WHOQOL-Brief (Hindi) instrument. Statistical analysis was done on SPSS version 10. Results revealed that old age patients had poor QOL in environmental domain. Female patients had poorer QOL in social relationship and environmental domains. Married patients had poorer QOL in physical, environmental domain, and their total QOL was also poor. There was a significant positive correlation with education status of patients, that is, higher educated patients had better QOL in environmental domain and negative correlation with family size, that is, more the number of family members poorer was the QOL in social relationship domain. Thus, to conclude many sociodemographic factors in the patients suffering from primary CDH have significant negative impact on QOL of patients. Among sociodemographic variables age, gender, marital status, and family size were the important factors that influence QOL of patients.

A comparison of psychosocial functioning in children and adolescents with chronic daily headache or juvenile fibromyalgia

Chronic pain has been found to have a negative impact on social and emotional functioning; however, these studies have typically focused either on functioning using combined samples of various pain conditions or on a single isolated condition. As a result, little is known about the differences between the various pediatric chronic pain disorders in terms of psychological functioning profiles, which can have a significant impact on associated pain disability. The purpose of the current study was to examine anxiety and depressive symptoms in children and adolescents (ages 10-18) diagnosed with juvenile primary fibromyalgia (JFM; N = 151) or Chronic Daily Headache (CDH; N = 168), and to assess the association of these symptoms with respective pain-related disability.

The Prevalence and Burden of Primary Headaches in China: A Population‐Based Door‐to‐Door Survey

In the absence of reliable data on the prevalence and burden of primary headache disorders in the mainland of China, a population-based survey was initiated by Lifting The Burden: the Global Campaign against Headache. Throughout all regions of China, 5041 non-related adult respondents aged 18-65 years were randomly sampled from the general population according to the expanded programme on immunization method established by World Health Organization. They were visited by door-to-door calling and surveyed using the structured questionnaire developed by Lifting The Burden, translated into Chinese and adapted to Chinese culture after a pilot study. The responder rate was 94.1%.The estimated 1-year prevalence of primary headache disorders was 23.8% (95%confidence interval 22.6-25.0%), of migraine 9.3% (95% confidence interval 8.5-10.1%), of tension-type headache (TTH) 10.8%(9.9-11.6%), and of chronic daily headache (CDH) 1.0% (0.7-1.2%). Of respondents with migraine, TTH, and CDH, moderate or severe impact and therefore high need for effective medical care were reported by 38.0%, 23.1%, and 47.9%, respectively.The World Health Organization quality of life-8 questionnaire showed that all 3 types of headache reduced life quality. The total estimated annual cost of primary headache disorders, including migraine,TTH, and CDH was CNY 672.7 billion, accounting for 2.24% of gross domestic product (GDP) (direct cost: CNY 108.8 billion, 0.36% of GDP; indirect cost: CNY 563.9 billion, 1.88%of GDP). The prevalence of primary headaches is high in China and not dissimilar from the world average. These headaches cause disability, impair work, study and daily activities, decrease life quality, and bring about a heavy and hitherto unrecognized socioeconomic burden.

Chronic Daily Headache in Children and Adolescents

Chronic daily headache (CDH) may be primary or secondary. Secondary causes can be suspected through "red flags" in the history and examination. With a prevalence of at least 1% and several associations, primary CDH is a common, often complex, chronic pain syndrome in children and adolescents. The intricate associations between stressors, psychiatric disorders (especially anxiety and depression), and CDH can be explained by "the limbically augmented pain syndrome" proposed by Rome and Rome. Disorders of sleep and other pain syndromes also may co-occur. For these reasons, a multiaxial classification is ideal. Many with primary CDH have features of both chronic migraine and chronic tension-type headache, contributing to confusion in subtyping. Primary CDH is often transformed from a primary episodic headache type, stressors being most responsible. Genetic factors also may facilitate chronification. Management should be biopsychosocial, family-centered, and often multidisciplinary, drugs being only one component. Treatment is still based on consensus, not evidence. Girls, migraineurs, and those with psychiatric comorbidity, medication overuse, and CDH onset before the age of 13years and lasting for 2years or longer, are at high risk for persistence; hence, such patients should be followed up into adult life. A classification for CDH should be included in the third edition of the International Classification of Headache Disorders.

Chronic Migraine, Classification, Differential Diagnosis, and Epidemiology

Chronic migraine (CM) is the most disabling of the 4 types of primary chronic daily headache (CDH) of long duration, a syndrome defined by primary headaches 15 or more days per month for at least 3 months with attacks that last 4 hours or more per day on average. CDH of long duration includes CM, chronic tension-type headache, new daily persistent headache, and hemicrania continua. CM affects approximately 2% of the adult population in Western countries, imposing substantial burdens on individual sufferers and their families and, more broadly, upon society. Although this disorder is highly disabling and prevalent, it remains largely underdiagnosed and undertreated. Diagnosing CM requires a systematic approach that includes these steps: (1) exclude a secondary headache disorder, and (2) diagnose a specific primary headache syndrome based on frequency and duration, for example, short-duration episodic, long-duration episodic, or long-duration chronic. CM usually develops as a complication of episodic migraine after a period of increasing headache frequency. This migraine transformation is associated with a number of risk factors, some of which cannot be modified, including age and race. Other risk factors for CM are modifiable, such as obesity, snoring, head injury, stressful life events, and overuse of opioids and barbiturates. However, risk factor modification has not yet been shown to decrease the likelihood of CM onset. According to a cross-sectional analysis of data from the American Migraine Prevalence and Prevention study published this year in Journal of Neurology, Neurosurgery, and Psychiatry, when compared to patients with episodic migraine, patients with CM were significantly less likely to be employed full-time and almost twice as likely to be occupationally disabled. In addition, patients with CM were nearly twice as likely to have anxiety, chronic pain, or depression. Furthermore, patients with CM had higher cardiovascular and respiratory risk, were 40% more likely to have heart disease and angina, and were 70% more likely to have a history of stroke. These findings highlight the paramount importance of clinical vigilance, accurate diagnosis, and appropriate, effective management - including treatment or referrals - to improve patient outcomes.

New Daily Persistent Headache: Clinical Perspective

New daily persistent headache is a recognized form of primary chronic daily headache. It is unique in its presentation and course. The goal of this article is to discuss the clinical characteristics, triggering factors, possible underlying pathogenesis and treatment options for this unique headache disorder. At present prognosis for new daily persistent headache is considered poor with very few effective treatment options. A new treatment paradigm for new daily persistent headache based on triggering events will be suggested. The current International Classification of Headache Disorders 2 criteria for new daily persistent headache will also be discussed including its apparent inadequacies and revised criteria will be recommended.

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 Daily–Persistent Headache Versus Tension-type Headache

New daily-persistent headache (NDPH) and chronic tension-type headache (CTTH) are two forms of primary chronic daily headache of long duration that often are similar in their headache manifestations. NDPH distinguishes itself from CTTH and the other forms of chronic daily headache by its continuous head pain from onset. However, despite formalized criteria that specify NDPH must resemble the acute onset of a headache identical to that of CTTH, NDPH commonly has migraine features. Here, we review the available literature on NDPH and compare its clinical features, epidemiology, prognosis, inciting factors, and treatment to CTTH.

New daily persistent headache and panic disorder

New daily persistent headache (NDPH) is a primary chronic daily headache that is generally considered to be difficult to treat. Migraine has been linked to comorbid psychiatric conditions, mainly mood and anxiety disorders, but NDPH has never been linked to psychiatric conditions, and never studied extensively for such an association. We report nine cases (six women and three men) of patients diagnosed with NDPH and panic disorder who were treated for both conditions. Six of them (66%) had good or excellent responses. The spectrum of anxiety disorders, particularly panic disorder, should be considered in NDPH patients. Simultaneous treatment of both disorders may lead to good outcomes.

Management of Headache in the Elderly

The diagnosis and management of headache disorders in the elderly are challenging. The evaluation of the elderly patient with new-onset or recurrent headache requires a grasp of the heterogeneous set of causes of secondary head pain disorders. Once such aetiologies are excluded, the correct primary headache disorder must be diagnosed. Although tension-type headache is the leading cause of new-onset headache in the elderly, other primary headache disorders such as migraine can manifest in later life, and one disorder, hypnic headache, occurs almost exclusively in the elderly. Primary chronic daily headache persists in elderly patients to a greater extent than the primary episodic headache disorders do. The treatment of elderly patients with primary headache disorders is multifaceted, including acute, prophylactic and at times transitional treatments. Knowledge of drug interactions is particularly important as polypharmacy is the rule. Concomitant illnesses may require adjustments in choice or dose of drugs. In addition, as many acute and preventive treatments are either contraindicated or poorly tolerated in the elderly, modifiable risk factors for headache progression and perpetuation must be addressed. In spite of these treatment complexities, there are numerous opportunities to bring relief to older patients with primary headache disorders from the currently available therapies. New treatment options for elderly patients with headache will soon be available, including acute, prophylactic and interventional techniques.

New daily-persistent headache

Chronic daily headache (CDH) is a descriptive term that encompasses 4 different headache disorders, each of which is characterized by frequent headaches. Primary CDH subtypes of long duration (i.e., 4 hours or more) are chronic migraine, chronic tension-type headache, hemicrania continua, and new daily-persistent headache (NDPH). NDPH, while not as common as chronic migraine or chronic tension-type headache, is common enough to be part of the general neurologist's practice, and is seen often in the headache specialist's office. First described in 1986,1 it gained acceptance when it was placed within the Silberstein-Lipton (S-L) criteria for chronic daily headache in 1994.2 The critical feature of the original description and the subsequent S-L description was the onset: daily headache starts abruptly without a background of frequent or worsening headache. Unfortunately, its diagnosis using International Classification of Headache Disorders (ICHD)–II3 criteria has been mired in controversy based on 2 separate issues: 1) the disparate descriptions of the degree …