Treatment Of Chronic Headache Research Articles

Effectiveness of transcranial direct current stimulation (tDCS) as adjunctive treatment for chronic headache in adults with clinically stable systemic lupus erythematosus (SHADE): a randomised double-blind multiarm sham controlled clinical trial

BackgroundChronic headache is a ‘silent’ neuropsychiatric systemic lupus erythematosus symptom with heterogeneous prevalence, potentially reaching 54.4%. It may reduce quality of life by increasing the likelihood of depression and sleep...

The status of knowledge on migraines: The role of microglia

Migraines are a considerable social problem and economic burden worldwide. Current acute treatments are based on inhibiting meningeal neurogenic inflammation which has poor results in some patients, whereas the site of action of prophylactic medicines are unknown; therefore, exploring new treatment mechanisms and methods is increasingly needed. Recent evidence suggests that microglia and microglia-mediated neuroinflammation are important in migraine pathogenesis. In the cortical spreading depression (CSD) migraine model, microglia were activated after multiple CSD stimulations, suggesting that microglial activation may be associated with recurrent attacks of migraine with aura. In the nitroglycerin-induced chronic migraine model, the microglial response to extracellular stimuli leads to the activation of surface purine receptors P2X4、P2X7、P2Y12, which mediate signal transduction through intracellular signalling cascades, such as the BDNF/TrkB, NLRP3/IL-1β and RhoA/ROCK signalling pathways, and release inflammatory mediators and cytokines that enhance pain by increasing the excitability of nearby neurons. Inhibition of the expression or function of these microglial receptors and pathways inhibits the abnormal excitability of TNC (trigeminal nucleus caudalis) neurons and intracranial as well as extracranial hyperalgesia in migraine animal models. These findings suggest that microglia may be central in migraine recurrent attacks and a potential target for the treatment of chronic headaches.

Educational and Supportive Self-Management Program for the Treatment of Chronic Headache.

Between 2017 and 2019, 736 patients with chronic headache, living in the United Kingdom, enrolled in a 12-month study. Approximately 83% of participants were women, with 99% experiencing either chronic migraine headache or chronic tension-type headache with episodic migraine.

Complementary and integrative medicine perspectives among veteran patients and VHA healthcare providers for the treatment of headache disorders: a qualitative study

ObjectiveTo evaluate veteran patient and provider perceptions and preferences on complementary and integrative medicine (CIM) for headache management.BackgroundThe Veterans Health Administration (VHA) has spearheaded a Whole Health system of care focusing on CIM-based care for veteran patients. Less is known about patients’ and providers’ CIM perceptions and preferences for chronic headache management.MethodsWe conducted semi-structured interviews with 20 veteran patients diagnosed with headache and 43 clinical providers, across 12 VHA Headache Centers of Excellence (HCoE), from January 2019 to March 2020. We conducted thematic and case comparative analyses.ResultsVeteran patients and VHA clinical providers viewed CIM favorably for the treatment of chronic headache. Specific barriers to CIM approaches included: (1) A lack of personnel specialized in specific CIM approaches for timely access, and (2) variation in patient perceptions and responses to CIM treatment efficacy for headache management.ConclusionVeteran patients and VHA clinical providers in this study viewed CIM favorably as a safe addition to mainstream headache treatments. Advantages to CIM include favorable adverse effect profiles and patient autonomy over the treatment. By adding more CIM providers and resources throughout the VHA, CIM modalities may be recommended more routinely in the management of veterans with headache.

Energy Imbalances and Chakras Energy Deficiencies Leading to Chloasma

Introduction: Chloasma is a condition in which dark patches appear on the skin, most commonly on the cheeks, bridge of the nose, forehead, upper lip, and chin – areas of the face that receive the most sun exposure. In Traditional Chinese Medicine (TCM) the causes of the disease could be Liver-Qi stagnation, Spleen-deficiency, Kidney-Yin-deficiency and Kidney-Yang deficiency. Purpose: The purpose of this study is to demonstrate that to have good results when treating chloasma, it is important to consider the root of the problem and not only the symptoms. Methods: Over two case reports, the first being a 42-year-old woman who sought Acupuncture treatment for chronic headache and had the doctor notice the skin stains disseminated on her face, especially in the cheeks area. The second case, a 48-year-old man with constant knee pain was on Acupuncture treatment, and at his physical examination, there was found several dark patches on his face. Both patients were diagnosed with energy imbalance (Yin, Yang, Qi and Blood) and were treated with Acupuncture sessions associated with Chinese dietary counseling. Results: Both patients had a significant improvement of the Chloasma patches, even thought that wasn’t the main cause of complaint. This overall recovery was achieved with the treatment of the patient in a holistic aspect, because when the energy imbalance that is causing problems is cared for, all the physical and / or emotional symptoms of one or several medical specialties improve at the same time. Conclusion: The treatment of Chloasma in TCM has a different point of view from Western medicine, by treating deeply the root cause of the problem in its energy level. Each patient has their own imbalance and the treatment must be individualized to have successful results.

Pulsed Radiofrequency of C2 Dorsal Root Ganglion Under Ultrasound-Guidance and CT Confirmed for Chronic Headache: Follow-Up of 20 Cases and Literature Review.

BackgroundChronic headache is common but difficult to treat. Most patients respond poorly to drugs. Nerve block is an effective treatment but has no continuous effect. The pulsed radiofrequency (PRF) technique has been shown to be effective in relieving head pain and extending the effect of nerve block.ObjectiveThe purpose of this study is to evaluate the long-term efficacy of C2 dorsal root ganglion after pulsed radiofrequency (PRF) guided by ultrasound for chronic headache.SettingThe Department of Pain Management, West China Hospital.MethodsTwenty patients who did not respond to medications and peripheral nerve blocks underwent ultrasound-guided PRF of the C2 dorsal root ganglion. The patients were followed up for 6 months. Visual analog scale (VAS) score was evaluated at 1 week, 1 month, 3 months, and 6 months. The quality of life (QOL) was assessed by Brief Pain Inventory (BPI) scores which were rated at pre-procedure and 1 month, 3 months, and 6 months after the procedure. The occurrence of complications was evaluated and reported.ResultsMean VAS scores were significantly decreased at 1 week, 1 month, 3 months and 6 months compared to the pre-procedure mean VAS score. Mean BPI scores decreased significantly at each postoperative time point compared to the preoperative baseline and low scores remained throughout the follow-up period: 45.05±3.44 at pre-procedure, 10.60 ± 2.37 at 1 weeks, 12.50 ± 2.46 at 1 month, 12.90 ± 2.62 at 3 months, and 11.63 ± 2.98 at 6 months. Mild complications occurred, including 1 case (4.7%) of transient cervicalgia (lasting for 24 hrs) and 3 cases (14.2%) of transient dizziness (lasting for 30 mins).LimitationsFirstly, it included a small sample of patients. Another is the short duration of the follow-up.ConclusionC2 PRF may be considered as an alternative treatment for chronic headache.

Discussion: The Cutting Edge of Headache Surgery: A Systematic Review on the Value of Extracranial Surgery in the Treatment of Chronic Headache

Discussion: The Cutting Edge of Headache Surgery: A Systematic Review on the Value of Extracranial Surgery in the Treatment of Chronic Headache

The Cutting Edge of Headache Surgery: A Systematic Review on the Value of Extracranial Surgery in the Treatment of Chronic Headache.

Migraine is a debilitating neurologic condition, with a large socioeconomic impact. There is a subgroup of patients that does not adequately respond to pharmacologic management and may have underlying neuralgia. Surgical decompression of extracranial sensory nerves has been proposed as an alternative therapy. The aim of this article is to review the evidence for the surgical treatment of neuralgias. A systematic review was conducted to study the efficacy of decompression of extracranial sensory nerves as a treatment for neuralgia. Clinical studies were included that studied patients, aged 18 years or older, diagnosed with any definition of headache and were treated with extracranial nerve decompression surgery. Outcome parameters included intensity (on a 10-point scale), duration (in days), and frequency (of headaches per month). Thirty-eight articles were found describing extracranial nerve decompression in patients with headaches. Postoperative decrease in headache intensity ranged from 2 to 8.2, reduction of duration ranged from 0.04 to 1.04 days, and reduction in frequency ranged between 4 and 14.8 headaches per month. Total elimination of symptoms was achieved in 8.3 to 83 percent of cases. A detailed summary of the outcome of single-site decompression is described. Statistical pooling and therefore meta-analysis was not possible, because of articles having the same surgeon and an overlapping patient database. Nerve decompression surgery is an effective way of treating headaches in a specific population of patients with neuralgia. Although a meta-analysis of the current data was not possible, the extracranial decompression of peripheral head and neck sensory nerves has a high success rate.

Chronic headache treatment: can we always follow international guidelines?

International guidelines on the prevention of migraine recommend the use of five main classes of medications: beta-blockers, antiepileptics, antidepressants (amitriptyline and venlafaxine), angiotensin receptor antagonists and botulinum toxin type A. Chronic tension-type headache (CTTH) guidelines are even more limiting and contain only amitriptyline, venlafaxine and mirtazapine. However, long-term intake of these medications is substantially limited by their tolerability issues. Moreover, most recommended medications cannot control the most frequently observed comorbidities, where depression plays the most important role in treatment selection, efficacy and long-term prognosis. This paper reviews the current migraine and CTTH prevention guidelines and complexities that physicians encounter with their use. The paper also includes a case series of treating chronic headache with a new multimodal antidepressant vortioxetine.

Radiofrequency Ablation for Treating Headache.

Examining the efficacy of radiofrequency ablation in treating headache conditions. The efficacy of radiofrequency ablation in treating headache conditions is not well studied. Chronic headache conditions can be difficult to treat with little consensus on management of headaches associated with pericranial neuralgias. In this retrospective study, we found that radiofrequency ablation is an effective and safe treatment for resistant headache conditions. This study is important as it describes a novel treatment for chronic headache which can benefit a large number of patients.

Chronic Headache Education and Self-management Study (CHESS) \u2013 a mixed method feasibility study to inform the design of a randomised controlled trial

BackgroundSelf-management support programmes are effective in a range of chronic conditions however there is limited evidence for their use in the treatment of chronic headaches. The aim of this study was to test the feasibility of four key aspects of a planned, future evaluative trial of a new education and self-management intervention for people with chronic headache: 1) recruiting people with chronic headache from primary care; 2) a telephone interview for the classification of chronic headaches; 3) the education and self-management intervention itself; and 4) the most appropriate patient reported outcomes (PROMS).MethodsParticipants were identified and recruited from general practices in the West Midlands of the UK. We developed a nurse-led chronic headache classification interview and assessed agreement with an interview with headache specialists. We developed and tested a group based education and self-management intervention to assess training and delivery receipt using observation, facilitator, and participant feedback. We explored the acceptability and relevance of PROMs using postal questionnaires, interviews and a smartphone app.ResultsFourteen practices took part in the study and participant recruitment equated to 1.0/1000 registered patients. Challenges to recruitment were identified. We did 107 paired headache classification interviews. The level of agreement between nurse and doctor interviews was very good. We piloted the intervention in four groups with 18 participants. Qualitative feedback from participants and facilitators helped refine the intervention including shortening the overall intervention and increasing the facilitator training time. Participants completed 131 baseline questionnaires, measurement data quality, reliability and validity for headache-specific and generic measures was acceptable.ConclusionThis study indicated that recruiting people with chronic headache from primary care is feasible but challenging, our headache classification interview is fit for purpose, our study intervention is viable, and that our choice of outcome measures is acceptable to participants in a future randomised controlled trial (RCT).Trial registrationISRCTN, ISRCTN79708100. Registered 16th December 2015, http://www.isrctn.com/ISRCTN79708100

经皮神经低频电刺激治疗慢性头痛的随机对照研究

经皮神经低频电刺激治疗慢性头痛的随机对照研究

Calcitonin gene-related peptide potentiated the excitatory transmission and network propagation in the anterior cingulate cortex of adult mice.

The neuropeptide of calcitonin gene-related peptide (CGRP) plays critical roles in chronic pain, especially in migraine. Immunohistochemistry and in situ hybridization studies have shown that CGRP and its receptors are expressed in cortical areas including pain perception-related prefrontal anterior cingulate cortex. However, less information is available for the functional roles of CGRP in cortical regions such as the anterior cingulate cortex (ACC). Recent studies have consistently demonstrated that long-term potentiation is a key cellular mechanism for chronic pain in the ACC. In the present study, we used 64-electrode array field recording system to investigate the effect of CGRP on excitatory transmission in the ACC. We found that CGRP induced potentiation of synaptic transmission in a dose-dependently manner (1, 10, 50, and 100 nM). CGRP also recruited inactive circuit in the ACC. An application of the calcitonin receptor-like receptor antagonist CGRP8-37 blocked CGRP-induced chemical long-term potentiation and the recruitment of inactive channels. CGRP-induced long-term potentiation was also blocked by N-methyl-D-aspartate (NMDA) receptor antagonist AP-5. Consistently, the application of CGRP increased NMDA receptor-mediated excitatory postsynaptic currents. Finally, we found that CGRP-induced long-term potentiation required the activation of calcium-stimulated adenylyl cyclase subtype 1 (AC1) and protein kinase A. Genetic deletion of AC1 using AC1−/− mice, an AC1 inhibitor NB001 or a protein kinase A inhibitor KT5720, all reduced or blocked CGRP-induced potentiation. Our results provide direct evidence that CGRP may contribute to synaptic potentiation in important physiological and pathological conditions in the ACC, an AC1 inhibitor NB001 may be beneficial for the treatment of chronic headache.

Effectiveness of Acupuncture as Auxiliary Treatment for Chronic Headache

ObjectivesTo assess the effectiveness of acupuncture as an auxiliary analgesic treatment for chronic headaches and the influence of this treatment on the quality of life, as the effectiveness of acupuncture in chronic headache is still controversial. MethodsThirty-four patients selected from a University Hospital Clinic on Chronic Pain were divided into two groups: True acupuncture (Group 1), in which the recommended points of the Traditional Chinese Medicine were used for each type of headache and sham acupuncture (Group 2), in which the needles were inserted into a device (the stick-on moxa), at the same points as Group 1. Both groups used the prescribed preventive medication for pain. The verbal numeric scale before (VNS0) and after (VNS1) treatment, the number of crisis, and the number of analgesics used during the first and second months of treatment were used for assessment. Quality of life was also assessed before and after treatment with the Brazilian version of the Quality of Life Questionnaire: SF-6D, 2002. ResultsThe true acupuncture group showed greater effectiveness in controlling pain in chronic headache, which was statistically significant in all domains compared to the sham acupuncture group, including quality of life. ConclusionsAcupuncture can be considered an auxiliary treatment for chronic headache, reducing the intensity of pain, the number of crisis, the quantity of analgesics used, and improving the quality of life in patients with this painful condition.

Evaluation of IncobotulinumtoxinA as Prophylactic Treatment of Chronic Headache in Veterans (P4.130)

Evaluation of IncobotulinumtoxinA as Prophylactic Treatment of Chronic Headache in Veterans (P4.130)

Group Education and Multidisciplinary Management for Chronic Headaches Among Adolescents in a Military Treatment Facility: A Retrospective Chart Review.

To assess the effect of group education on the frequency of chronic headaches among adolescents. Chronic headaches are a common problem among adolescents with significant psychosocial morbidity. Brief education on lifestyle interventions to decrease headache frequency has established benefits among adult patients but is less proven among adolescents. This study is a chart review examining our experience with a group education program for 155 adolescents, aged 12-17 years old, enrolled in the U.S. military medical system with at least 3 months of chronic headaches who were referred to a headache evaluation clinic. The primary outcome of our study was self-reported number of days with a headache in the previous 30 days based on patient recall. We used a paired samples t-test to measure the change in headache frequency between the frequency reported at the headache class and follow-up more than 6 months after the class. Most of the adolescents seen in the program were female (114/155 [73.5%]) and suffered from migraine headaches (108/155 [69.8%]). Severe headache-related disability was reported by 40.6% of subjects (63/155). Subjects reported an average of 19 days with headache during the previous 30 days. Females and patients with higher headache-related disability reported a higher number of days with headache. Participation in the group education was associated with an 11.5 (SD 11.9, P < .001) day decrease in the frequency of headaches during the previous 30 days at follow-up at least 6 months after the class, with largest decline seen in patients with the highest level of migraine-related disability at baseline. Based on our retrospective chart review study, group education on headache evaluation and lifestyle management has potential as an effective, low-cost intervention for treatment of chronic headaches among adolescents.

Prognostic factors for chronic headache: A systematic review.

Objective:To identify predictors of prognosis and trial outcomes in prospective studies of people with chronic headache.Methods:This was a systematic review of published literature in peer-reviewed journals. We included (1) randomized controlled trials (RCTs) of interventions for chronic headache that reported subgroup analyses and (2) prospective cohort studies, published in English, since 1980. Participants included adults with chronic headache (including chronic headache, chronic migraine, and chronic tension-type headache with or without medication overuse headache). We searched key databases using free text and MeSH terms. Two reviewers independently extracted data and assessed the methodologic quality of studies and overall quality of evidence identified using appropriate published checklists.Results:We identified 16,556 titles, removed 663 duplicates, and reviewed 199 articles, of which 27 were included in the review—17 prospective cohorts and 10 RCTs with subgroup analyses reported. There was moderate-quality evidence indicating that depression, anxiety, poor sleep and stress, medication overuse, and poor self-efficacy for managing headaches are potential prognostic factors for poor prognosis and unfavorable outcomes from preventive treatment in chronic headache. There was inconclusive evidence about treatment expectations, age, age at onset, body mass index, employment, and several headache features.Conclusions:This review identified several potential predictors of poor prognosis and worse outcome postinterventions in people with chronic headache. The majority of these are modifiable. The findings also highlight the need for more longitudinal high-quality research of prognostic factors in chronic headache.

Sphenopalatine Ganglion Block in the Management of Chronic Headaches.

Sphenopalatine ganglion (SPG) block has been used by clinicians in the treatment of a variety of headache disorders, facial pain syndromes, and other facial neuralgias. The sensory and autonomic fibers that travel through the SPG provided the scientific rationale for symptoms associated with these head and neck syndromes. Yet, despite the elucidation of this pathogenic target, the optimal method to block its pain-producing properties has not been determined. Clinicians have developed various invasive and non-invasive techniques, each of which has shown variable rates of success. We examined the available studies of sphenopalatine ganglion blockade and its efficacy in the treatment of cluster headaches, migraines, and other trigeminal autonomic cephalalgias. Studies have demonstrated that SPG blockade and neurostimulation can provide pain relief in patients with cluster headaches, migraines, and other trigeminal autonomic cephalalgias. Patients with these conditions showed varying levels and duration of pain relief from SPG blockade. The efficacy of SPG blockade could be related to the different techniques targeting the SPG and choice of therapeutic agents. Based on current studies, SPG blockade is a safe and effective treatment for chronic headaches such as cluster headaches, migraines, and other trigeminal autonomic cephalalgias. Future studies are warranted to define the optimal image-guided technique and choice of pharmacologic agents for SPG blockade as an effective treatment for chronic headaches related to activation of the sphenopalatine ganglion.

A Prospective Cohort Study of Outpatient Interdisciplinary Rehabilitation of Chronic Headache Patients.

To evaluate the efficacy of an intensive outpatient program designed to improve functioning and reduce psychological impairment in chronic headache patients. Chronic headaches, occurring 15 or more days per month, for three or more months, may arise from multiple International Classification of Headache Disorders diagnoses: Chronic Migraine, Chronic Tension Type Headache, New Daily Persistent Headache, Chronic Post Traumatic Headaches, and Medication Overuse Headache. Several interdisciplinary programs that treat patients with chronic headaches have reported decreases in headache frequency. This study sought to evaluate the effect of a 3 week interdisciplinary treatment program for patients with chronic headache disorders on headache severity, functional status, and psychological impairment. Subjects were 379 patients admitted to an outpatient chronic headache treatment program. Assessments of headache severity, psychological status, and functional impairment were completed by 371 (97.8%) of these at the time of admission. At discharge, 340 subjects (89.7%) provided assessment data, and 152 (40.1%) provided data at 1-year follow-up. Subjects' mean ratings on a 0-10 scale for their headache pain in the prior week declined, and these improvements were maintained at follow-up. (Estimated marginal means on a 0-10 scale for Average pain: admission 6.1, discharge 3.5, follow-up 3.3; for Least pain: admission 3.2; discharge 1.5; follow-up 1.3; for Worst pain: admission 8.2; discharge 6.4; follow-up 5.7), and similar results were found for current pain (admission 4.7; discharge 2.8; follow-up 2.4): Measures of functional impairment also improved following treatment, and these gains were maintained at 12 month follow up (Estimated marginal mean Headache Impact Test-6 score: admission 66.1, discharge 55.4, follow-up 51.9; Estimated marginal mean Pain Disability Index score: admission 36.2, discharge 14.1, follow-up 11.6). As measured by the Depression, Anxiety and Stress Scale, anxiety and reactivity to stress decreased following treatment, and remained improved at follow-up (Estimated marginal mean score for Anxiety: admission 8.7, discharge 5.2, follow-up 4.4; Estimated marginal mean score for stress: admission 14.9, discharge 7.2, follow-up 7.6). Depression decreased with treatment, but while 1-year follow-up depression scores remained significantly lower than at admission, they were also significantly higher than at discharge (Estimated marginal means: admission 13.3, discharge 4.1, follow-up 6.6). The study supports the efficacy of the treatment model. Limitations of the study and suggestions for future research are also discussed.

Anatomical Regional Targeted (ART) BOTOX Injection Technique: A Novel Paradigm for Migraines and Chronic Headaches.

Migraine headaches are a debilitating disease that causes significant socioeconomic problems. One of the speculated etiologies of the generation of migraines is peripheral nerve irritation at different trigger points. The use of Onabotulinum toxin A (BOTOX), although initially a novel approach, has now been determined to be a valid treatment for chronic headaches and migraines as described in the Phase III Research Evaluating Migraine Prophylaxis Therapy trials that prompted the approval by the Food and Drug Administration for treatment of chronic migraines. The injection paradigm established by this trial was one of a broad injection pattern across large muscle groups that did not always correspond to the anatomical locations of nerves. The senior author developed the Anatomical Regional Targeted BOTOX injection paradigm as an alternative to the current injection model. This technique targets both the anatomical location of nerves known to have causal effects with migraines and the region where the pain localizes, to provide relief across a wide distribution of the peripheral nerve. This article serves as a guide to the Anatomical Regional Targeted injection technique, which, to our knowledge, is the first comprehensive BOTOX injection paradigm described in the literature for treatment of migraines that targets nerves and nerve areas rather than purely muscle groups. This technique is based on the most up-to-date anatomical and scientific studies and large-volume migraine surgery experience.