Subtype Of Chronic Daily Headache Research Articles

A New Subtype of Chronic Daily Headache Presenting in Older Women

To describe a new subtype of chronic daily headache in women of a specific age group. Case series. Eight patients were included in the presented case series. The average age of onset of this distinct headache condition is 57 years. All patients were either perimenopausal or in menopause when the headaches started. The syndrome is marked by bilateral head pain that starts daily from onset and is typically at its most severe intensity the first thing in the morning before arising or when in the supine position. Immediate worsening in Trendelenburg appears to be an almost diagnostic test for the syndrome and occurred in all patients. The majority of the patients had a history of episodic migraine, but the migraines were either very well controlled or had ceased by the time the new headache arose. The bulk of the patients (6/8) were either overweight or obese, although two patients were of normal body mass index (BMI). Neuroimaging showed no abnormalities. All patients responded to cerebrospinal fluid (CSF) pressure-/volume-lowering medications (acetazolamide or spironolactone), but only one patient was able to completely taper off treatment without headache recurrence. This newly defined subtype of chronic daily headache appears to be caused by a state of elevated CSF pressure. It is hypothesized that a combination of an elevated BMI and the presence of cerebral venous insufficiency leads to this form of daily headache.

Chronic Daily Headache and Medication Overuse Headache in First-Visit Headache Patients in Korea: A Multicenter Clinic-Based Study.

Background and PurposeChronic daily headache (CDH) is defined as a headache disorder in which headaches occur on a daily or near-daily basis (at least 15 days/month) for more than 3 months. Chronic migraine (CM) and medication overuse headache (MOH) are very disabling headaches that remain underdiagnosed. The aim of this study was to establish the frequency of CDH and its various subtypes, and examine the associations with MOH among first-visit headache patients presenting at neurology outpatient clinics in Korea.MethodsEleven neurologists enrolled first-visit patients with complaints of headaches into outpatient clinics for further assessment. Headache disorders were classified according to the International Classification of Headache Disorder (third edition beta version) by each investigator.ResultsPrimary CDH was present in 248 (15.2%) of the 1,627 included patients, comprising CM (143, 8.8%), chronic tension-type headache (CTTH) (98, 6%), and definite new daily persistent headache (NDPH) (7, 0.4%). MOH was associated with headache in 81 patients (5%). The association with MOH was stronger among CM patients (34.5%) than patients with CTTH (13.3%) or NDPH (14.3%) (p=0.001). The frequency of CDH did not differ between secondary and tertiary referral hospitals.ConclusionsThe frequencies of CDH and MOH diagnoses were 15.2% and 5%, respectively in first-visit headache patients presented at secondary or tertiary referral hospitals in Korea. CM was the most common subtype of CDH and was most frequently associated with MOH.

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.

Recent Approaches and Development of Acupuncture on Chronic Daily Headache.

Chronic daily headache (CDH) is a very important part of primary headache disorder, and it causes heavy socioeconomic burden. An increasing number of people are suffering from CDH, and there are many treatment choices for the different subtypes of CDH. However, the definite effect of these treatments, especially the non-pharmacologic treatments, is still unclear and controversial. Acupuncture, a key component of Traditional Chinese Medicine (TCM), has an over 2500-year history in China as an effective non-pharmacologic method for chronic pain, but the researches on CDH are limited. Varying stimulations and the acupoints can be chosen for different acupuncturists, and there are many primary and secondary assessments of the therapeutic effect. Although acupuncture has been shown to have potential effects on CDH, it requires much deeper researches on the optimized usage and underlying mechanisms.

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.

Association of psychiatric co-morbidity and efficacy of treatment in chronic daily headache in Indian population.

Objective:To study the prevalence of psychiatric co-morbidity in patients of chronic daily headache (CDH) and compare the efficacy of treatment between various type of headache associated with psychiatric co-morbidity.Materials and Methods:Prospective case control cohort study, 92 consecutive patients of CDH meeting eligibility criteria. The diagnosis of various subtypes of CDH was made according to the IHS criteria. Age, sex, educational, marital and socioeconomic status, matched controls were also selected. Patients were evaluated with the Mini International Neuropsychiatric Interview (MINI) scale at the time of enrolment and at 3 months.Results:CDH accounted for 28% of all headache patients. The mean age of presentation was 30.2 ± 10.3 years, male: Female ratio of 28:64 and mean duration of 4.56 ± 0.56 years. Chronic migraine (CM) accounted for 59 patients, chronic tension type headache (CTTH) 22 patients, new daily persistent headache (NDPH) 3 patients and miscellaneous 8 patients. Psychiatric co-morbidity was present in 53.3% patients with CDH, and was more common in CM (62.7%) as compared to CTTH (36.4%). Single psychiatric co-morbidity was seen in 26 patients, while 23 patients had multiple co-morbidity. Major depressive episode, anxiety disorder, agoraphobia and dysthymia were significant psychiatric co-morbidities. Patients with CM were treated with topiramate or divalproex sodium ER and CTTH were treated with amitriptyline. 55 patients came for follow up at 3 months, improvement in headache was seen in 29 patients.Conclusion:Psychiatric co-morbidity was present in more than 50% patients with CDH and its presence along with a duration of ≥2 years was associated with a poor response to treatment.

Juvenile myoclonic epilepsy presenting as a new daily persistent-like headache

New daily persistent headache (NDPH) is a recognized subtype of chronic daily headache with a unique presentation of a daily headache from onset typically in individuals with minimal or no prior headache history. Various secondary mimics of NDPH have now been documented but at present there has been no association made between primary epilepsy syndromes and new daily persistent-like headaches. A case patient is presented who developed a daily continuous headache from onset who 3 months after headache initiation had her first generalized tonic-clonic seizure. Further investigation into her history and her specific EEG pattern suggested a diagnosis of juvenile myoclonic epilepsy (JME). Her NDPH and seizures ceased with epilepsy treatment. Clinically relevant was that the headache was the primary persistent clinical symptom of her JME before the onset of generalized tonic-clonic seizures. The current case report adds another possible secondary cause of new daily persistent-like headaches to the medical literature and suggests another association between primary epilepsy syndromes and distinct headache syndromes.

Prevalence and Burden of Chronic Migraine in Adolescents: Results of the Chronic Daily Headache in Adolescents Study (C‐dAS)

To estimate the prevalence of chronic migraine (CM) among adolescents and to describe the epidemiologic profile, headache characteristics, disability, and healthcare utilization of adolescents with CM in the USA. Chronic daily headache (CDH) and CM occur in children and adolescents, but are poorly understood in these populations because their presentation is different from that in adults. It may be difficult to assign a definitive diagnosis to young people suffering from CDH because symptoms may fail to meet the criteria for one of the CDH subtypes. A large sample of households with at least one resident aged 12 to 19 years was selected in balance with the US Census. Data were collected in 3 phases: (1) mailed questionnaire; (2) telephone interview; and (3) 30-day interactive voice response system diary. CM prevalence was estimated by adapting the second edition of the International Classification of Headache Disorders criteria for CM to include pediatric migraine diagnostic criteria. The population was stratified for medication overuse. Medication overuse was defined as 15 or more days per month of acute medication use. Included in the study were measures of headache characteristics, headache impact (Headache Impact Test), disability (Pediatric Migraine Disability Assessment), and healthcare and medication use. Data are reported on subjects 12 to 17 years of age only. The US adolescent (12-17 years) prevalence rate for CM was 0.79% (0.00-1.70) excluding those with medication overuse and 1.75% (0.62-2.89) when adolescents with medication overuse were included. The majority of adolescents with CM had Headache Impact Test scores greater than or equal to 60, indicating severe headache impact, and mean Pediatric Migraine Disability Assessment scores greater than 17, indicating severe headache and disability. The majority of adolescents with CM (approximately 60%) had not visited a healthcare provider in the previous year and less than one in 5 reported taking medications to prevent headaches during the last month. Results suggest that CM occurs less frequently in adolescents than adults, but like adults, adolescents are severely burdened by the disorder. Data support an unmet medical need; however, the development of optimal criteria for diagnosing adolescents with CM is critical to fully understanding how medical needs can be met within this complex population.

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 …

Chronic tension-type headache

Tension-type headache is the most common headache type worldwide. Chronic tension-type headache (CTTH) affects 2% to 3% of patients, yet it represents the least talked about subtype of chronic daily headache. There is much debate in the headache community on whether CTTH exists as its own entity or is a milder form of chronic migraine (CM), because there are similarities and differences between the two headache forms. This article reviews CTTH, as well as the current pathophysiology and treatment, and discusses controversial issues in the diagnosis of CTTH and CM.

Post-infectious new daily persistent headache may respond to intravenous methylprednisolone

New daily persistent headache (NDPH) is a subtype of chronic daily headache (CDH) that starts acutely and continues as a daily headache from the onset. It is considered as one of the most treatment refractory of all headache syndromes. The pathophysiology is largely unknown. Viral infections, extracranial surgery, and stressful life events are considered as triggers for the onset of NDPH. A few patients may have the onset of their symptoms during an infection. Here we report nine patients with NDPH like headache. All of them had a history suggestive of extracranial infections a few weeks prior to the onset of headache. All patients received intravenous methyl prednisolone (IV MPS) for 5 days. Intravenous MPS was followed by Oral steroids for 2–3 weeks in six patients. The relief of headache started between the second and fifth days of infusion in all patients. The steady improvement in headache continued and seven patients experienced almost complete improvement within 2 weeks. Two other patients showed complete improvement between 6 and 8 weeks after initiation of IV MPS therapy. We conclude that NDPH-like headache may occur as a post infectious process following a recent infection. We also speculate on the possible mechanisms of headache in our patients.

A 13-Year Long-Term Outcome Study of Elderly With Chronic Daily Headache

We established a cohort of 60 subjects with chronic daily headache (CDH) out of 1533 community-based elderly in 1993 and finished two short-term follow-ups in 1995 and 1997. All of the 26 survivors without dementia (4 M/22 F, mean age 82.7 +/- 3.4 years) finished the follow-up in 2006. The mean headache frequency was 8.4 +/- 11.8 days per month in the past year, and seven (27%) had persistent CDH. Based on the International Classification of Headache Disorders, 2nd edn, the CDH subtypes diagnoses were chronic migraine in three subjects, chronic tension-type headache in three, and one with medication-overuse headache. All these seven subjects had CDH during the 1995 and 1997 follow-ups. The diagnosis of CDH with migrainous features increased from 25 to 71% in those with CDH from 1993 to 2006. Migraine was the most common headache type in those with CDH resolution. Aggressive treatment should be applied especially for those with persistent CDH at short-term follow-ups.

Epidemiology, Risk Factors, and Treatment of Chronic Migraine: A Focus on Topiramate

The term chronic daily headache refers to a heterogeneous group of headache disorders characterized by a frequency of headaches on > or = 15 days per month. Chronic migraine is a subtype of chronic daily headache. The prevalence of chronic migraine is approximately 1%. Baseline attack frequency and acute medication overuse have been identified as potential risk factors for the progression of migraine from an episodic disorder to a chronic condition. There is an unmet patient need for effective and safe treatments for patients with chronic migraine, but data from rigorous controlled trials are limited. Previous studies have demonstrated that topiramate is an effective and safe preventive treatment for episodic migraine. In addition, pilot studies have suggested the utility of topiramate for the prevention of chronic migraine. Two randomized, double-blind, placebo-controlled, multicenter trials investigating the efficacy and safety of topiramate in the treatment of patients with chronic migraine have recently been completed. This review presents comparative data from these 2 clinical trials, which suggest that topiramate at a dose of 100 mg daily is effective and generally well tolerated in chronic migraine.

Childhood chronic daily headache: a biopsychosocial perspective

The aim of our observational study was to highlight some clinical observations on chronic daily headache (CDH) in children and adolescents. Data on patients < or =18 years aged presenting with CDH to the Pediatric Headache Clinic at the Royal University Hospital, Saskatoon, Canada, were collected prospectively and sequentially from February 2004 to July 2006. Standardized data sheets and definitions were used. Follow-up information on the 70 participants (22 males, 48 females) was current to February 2007. Fifty-four participants (77%) had had recurrent headaches before transformation to CDH. Comorbid chronic migraine and chronic tension-type headache was the most frequent subtype of CDH (37 participants; 53%). Anxiety and mood disorders were diagnosed in 17 and 15 children respectively. Stressors that precipitated or contributed to the maintenance of CDH were judged important in 44 (63%). The possibility of a somatoform disorder was considered in five children, a factitious disorder in one, and malingering in another. We suggest that CDH be viewed from a biopsychosocial rather than a narrow biomedical perspective and the classification improved to enhance clinical utility.

The classification of chronic daily headache in French children and adolescents: a comparison between the second edition of the International Classification of Headache Disorders and Silberstein-Lipton criteria.

Few data are available on the applicability of both the criteria proposed by Silberstein and Lipton (S-L) and the International Classification of Headache Disorders-II (ICHD-II) in the classification of children and adolescents with chronic daily headache (CDH). The International Headache Society recently added revised criteria (ICHD-IIR) for chronic migraine to its Appendix. We retrospectively reviewed all charts of 34 children and adolescents (<17 years) with primary CDH presenting to the outpatient clinic of the Universitary Department of Neuropediatrics of Lille between February 2004 and February 2006 and tried to classify their CDH according to both S-L criteria and the recently published ICHD-IIR. Thirty-two children (94%) and 33 children (97%) could respectively be successfully classified into one subtype of CDH according to the S-L classification and the ICHD-IIR. Transformed migraine was the most common diagnosis (61.8%), followed by new daily-persistent headache (20.6%) when the S-L criteria were used. Twenty-three children and adolescents (67.6%) could be classified under one of the migraine categories according to the ICHD-IIR classification. We think that both S-L and ICHD-II classifications, when used with detailed headache histories and diaries, are adequate to classify chronic daily headache in children and adolescents.

Psychiatric comorbidity and suicide risk in adolescents with chronic daily headache

To investigate the prevalence and correlates of comorbid psychiatric disorders and suicidal risk in community-based adolescents with chronic daily headache (CDH). We identified and recruited 122 adolescents with CDH from a non-referral student sample (n = 7,900). CDH subtypes were classified according to the most updated criteria of the International Classification of Headache Disorders, 2nd edition (ICHD-2). An in-person psychiatric interview was performed with each subject with CDH to assess depressive and anxiety disorders and suicidal risk based on the Mini-International Neuropsychiatric Interview-Kid (MINI-Kid). Clinical correlates and impacts were investigated. A total of 121 subjects (31 male/90 female, mean age 13.8 years) finished the psychiatric interview. Fifty-seven subjects (47%) had > or =1 assessed psychiatric comorbidity with major depression (21%) and panic disorder (19%) as the two most common diagnoses. Current suicidal risk was assessed as high (score > or = 10) in 20% of subjects. Female gender and older age were associated with depressive disorders. Presence of migraine was associated with psychiatric comorbidities (OR = 3.5, p = 0.002). The associations with psychiatric disorders were stronger for migraine with aura than for migraine without aura. Migraine with aura also independently predicted a high suicidal risk (score > or = 10) (adjusted OR = 6.0, p = 0.028). In contrast, CDH subtypes, headache frequencies, or medication overuse were not correlated. Comorbid psychiatric disorders were not related to physician consultations or more days of sick leave. This community-based study showed high comorbidity of psychiatric disorders and suicidal risk in adolescents with chronic daily headache. The presence of migraine attacks, especially migraine with aura, was the major predictor for these associations.

From Transformed Migraine to Episodic Migraine: Reversion Factors

To identify the factors contributing to the reversion of transformed migraine (TM) into episodic migraine. TM, the most common and important subtype of chronic daily headache (CDH), has a great effect on a patient's quality of life. However, its clinical course and outcome predictors have rarely been studied prospectively. Of 1142 consecutive headache patients seen at the Headache Clinic of the Samsung Medical Center, the patients with TM (frequency >15/month for >6 months and a history of migraine meeting the ICHD-II diagnostic criteria) were followed for at least 1 year. We analyzed the demographic data, clinical course, and compliance factors, such as those of the physician's management protocol and recommended lifestyle modification. A total of 136 patients finished the final follow-up assessment 1 year after the initial evaluation. Ninety-five patients (70%) converted from TM to episodic migraine. Forty-one patients (30%) continued to suffer daily headaches without a period of improvement. The demographic and clinical information collected before the treatment was not significantly related to outcome, except for chronic use of analgesics for other medical conditions (P= .01). Of the compliance factors, good compliance with preventive medication (P < .001), withdrawal from continuous use of analgesics for headache relief (P < .001), and regular exercise (P= .04) were significant positive contributors to the reversion of TM into episodic migraine. Compliance factors are the most important factors that determine the reversion of TM into episodic migraine.

The Classification of Chronic Daily Headache in Adolescents—A Comparison Between the Second Edition of the International Classification of Headache Disorders and Alternative Diagnostic Criteria

To compare the second edition of the International Classification of Headache Disorders (ICHD-2) and the Silberstein-Lipton (S-L) criteria in the classification of adolescents with chronic daily headache (CDH). We reviewed the clinical records and the headache diaries of 170 adolescents (13 to 17 years) seen between 1998 and 2003 at a headache center. Relevant information was transferred to a standardized form that included operational criteria for the ICHD-2. CDH subtypes were classified according the criteria proposed by S-L into transformed migraine (TM) with (TM+) and without medication overuse (TM-), chronic tension-type headache (CTTH), new daily persistent headache (NDPH), and hemicrania continua (HC). From the 69 patients with TM- according the S-L criteria, most (71%) could be classified as chronic migraine (CM), while a minority of patients required a combination of diagnosis, mainly migraine and CTTH (14.4%). Of the patients with TM+, just 39.6% met the criteria for probable CM (PCM) with probable medication overuse (PMO). If instead of 15 migraine days per month, we considered 15 or more days of migraine or probable migraine, 84% of the subjects with TM- and 68.7% of those with TM+ could be classified. Of the 27 subjects classified as NDPH without medication overuse according to the S-L system, the majority (51.2%) were also classified as NDPH according the ICHD-2. Interestingly, three (11.1% of the subjects with NDPH without medication overuse) were classified as CM in the ICHD-2 because these patients had an abrupt onset of 15 or more days of migraine per month. All patients with NDPH with medication overuse according to the S-L criteria required a combination of diagnoses in the ICHD-2. All subjects with CTTH received a single diagnosis in both classification systems. (i) Among adolescents with TM, the majority (58.1%) could be classified as CM, according to the ICHD-2. These results were driven by TM without medication overuse. (ii) If the ICHD-2 criteria for CM are revised to require 15 days of migraine or probable migraine, the proportion of patients with TM- who meet the criteria for CM increases from 71% to 84%; for TM+, the proportion with probable chronic migraine and PMO increases from 30% to 68%. (iii) About half of the patients with NDPH according to the S-L criteria have too many migraine features to meet ICHD-2 criteria for NDPH.

Chronic headache: new advances in treatment strategies.

Neurology. 2002;59(5 suppl 2):S8‐S13.Chronic daily headache (CDH) affects approximately 4 to 5% of the population and encompasses a number of different diagnoses, including transformed migraine, chronic tension‐type headache (TTH), new‐onset daily persistent headache, and hemicrania continua. Although the pathophysiology of CDH is still poorly understood, some research has suggested that each of the various subtypes of CDH may have a different pathogenesis. The goals of prophylactic therapy are to reduce the frequency, severity, and duration of headache attacks; to improve responsiveness to treatment of acute attacks; to improve function; and to reduce disability. However, opinions differ as to exactly which are the best and most appropriate outcome measures for prophylaxis. Several pharmacologic treatment options exist, including antidepressants, anticonvulsants, muscle relaxants, serotonin agonists, ergots, serotonin antagonists, antianxiety agents, and other miscellaneous drugs. Tizanidine, an alpha(2)‐adrenergic agonist, has recently emerged as a promising prophylactic adjunct for CDH, which implicates a central alpha(2)‐adrenergic mechanism as an important factor in the pathophysiology of CDH. Comment: Drs. Lake and Saper provide a superb overview of frequent headache, and taken with Dr. Silberstein's article described above, the two reviews constitute the most up‐to‐date reviews on the subject. SJT

Psychiatric comorbidity of chronic daily headache: impact, treatment, outcome, and future studies.

Patients with chronic daily headache have high frequencies of psychiatric comorbidity or psychologic distress in clinic-based studies. The presence of psychologic distress contributes to poor quality of life in patients with chronic daily headache. Antidepressants are effective in the treatment of chronic daily headache and its comorbid depression symptoms, although there is a discrepancy in the treatment response between chronic daily headache and comorbid depression. Comorbid major depression was a poor outcome predictor for chronic daily headache in clinic-based studies; however, the presence of psychologic distress did not predict the prognosis in population-based studies.A systematic investigation of psychiatric comorbidity is emphasized in patients with chronic daily headache and aims at a more comprehensive clinical management. Large-scale, longitudinal surveys and clinical trials specifically for psychiatric comorbidity of chronic daily headache are warranted to answer whether a syndromic relationship exists between different chronic daily headache subtypes and different psychiatric disorders, and to provide evidence-based treatment options for this large group of patients.