Guideline on the preventive treatment of chronic migraine, chronic tension type headache, hemicrania continua and new daily persistent headache on behalf of the Colombian Association of Neurology / Guía de la Asociación Colombiana de Neurología para el tratamiento preventivo de la migraña crónica, cefalea tipo tensión crónica, hemicránea continua y cefalea diaria persistente de novo

SUMMARY INTRODUCTION: Chronic daily headache is a high impact entity in the general population. Although chronic migraine and tension-type headache are the most frequent conditions, it is necessary to consider hemicrania continua and new daily persistent headache as part of the differential diagnoses to perform a correct therapeutic approach. OBJECTIVE: To make recommendations for the treatment of chronic daily headache of primary origin METHODOLOGY: The Colombian Association of Neurology, by consensus and Grade methodology (Grading of recommendations, assessment, development and evaluation), presents the recommendations for the preventive treatment of each of the entities of the daily chronic headache of primary origin group. RESULTS: For the treatment of chronic migraine, the Colombian Association of Neurology recommends onabotulinum toxin A, erenumab, topiramate, flunarizine, amitriptyline, and naratriptan. In chronic tension-type headache the recommended therapeutic options are amitriptyline, imipramine, venlafaxine and mirtazapine. Topiramate, melatonin, and celecoxib for the treatment of hemicrania continua. Options for new daily persistent headache include gabapentin and doxycycline. The recommendations for inpatient treatment of patients with chronic daily headache and the justifications for performing neural blockades as a therapeutic complement are also presented. CONCLUSION: The therapeutic recommendations for the treatment of chronic daily headache based on consensus methodology and Grade System are presented.

RESUMEN INTRODUCCIÓN: La cefalea crónica diaria es una entidad de alto impacto en la población general. Aunque la migraña crónica y la cefalea tipo tensión son las condiciones más frecuentes, es necesario considerar la hemicránea continua y la cefalea diaria persistente de novo como parte de los diagnósticos diferenciales para realizar un enfoque terapéutico correcto. OBJETIVO: Hacer recomendaciones para el tratamiento de la cefalea crónica diaria de origen primario METODOLOGÍA: La Asociación Colombiana de Neurología, mediante consenso y metodología GRADE (Grading of Reccomendations, Assesment, Development and Evaluation), presenta las recomendaciones para el tratamiento preventivo de cada una de las entidades del grupo de la cefalea crónica diaria de origen primario. RESULTADOS: Para el tratamiento de la migraña crónica, la Asociación Colombiana de Neurología recomienda onabotulinum toxina A, erenumab, galcanezumab, fremanezumab, topiramato, flunarizina, amitriptilina y naratriptan. En cefalea tipo tensional crónica las opciones terapéuticas recomendadas son amitriptilina, imipramina, venlafaxina y mirtazapina. Para el tratamiento de la hemicránea continua topiramato, melatonina y celecoxib. Las opciones para cefalea diaria persistente de novo incluyen gabapentin y doxiciclina. Se presentan adicionalmente las recomendaciones para el tratamiento intrahospitalario de los pacientes con cefalea crónica diaria y las justificaciones para la realización de bloqueos neurales como complemento terapéutico. CONCLUSIÓN: se presentan las recomendaciones terapéuticas para el tratamiento de la cefalea crónica diaria basado en metodología de consenso y sistema GRADE.

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

BACKGROUND AND PURPOSE: Chronic 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. METHODS: Eleven 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. RESULTS: Primary 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. CONCLUSIONS: The 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.

Emergency and Inpatient Treatment of Migraine: An American Headache Society Survey.

Objective: To determine the medication and management preferences of headache specialists in treating migraine in the ED and during inpatient hospitalization. Background: Despite the frequency of migraine as a presenting complaint and the cost of acute treatment, there is no clear consensus on the standard of care for acute migraine management in the ED or during hospitalization. Methods: The American Headache Society (AHS) Special Interest Group for Inpatient and Emergency Care developed an online survey that was distributed to AHS members. Results: There were 106 survey respondents, 87 of whom completed all 13 questions. The most frequent choices for first-line ED migraine treatment in an otherwise healthy adult were dopamine antagonists (58.7%), non-steroidal anti-inflammatory drugs (NSAID) (49.0%), and IV hydration (48.1%). The most frequently selected second-line treatments were valproic acid, dihydroergotamine (DHE), and NSAIDs. Opioids were chosen by 1% for first line and 4.8% for second line. No respondents selected barbiturate containing medications for either treatment. The most frequently selected medications for initial treatment during inpatient hospitalization for migraine were DHE (64.5%), dopamine antagonists (61.3), and NSAID (37.6%). The most frequent adjunctive treatments were valproic acid and corticosteroids. Vomiting, medication overuse with opioids or barbiturates, and ED recidivism were the most frequently selected indications for inpatient treatment. The majority of respondents (71%) indicated they would taper or stop opioid medication as a part of migraine treatment in patients admitted for intractable migraine who were taking opioids for an unrelated indication such as low back pain. Commonly selected ancillary services included psychology (80.6%), physical therapy (64.5%), nutrition (50.5%), and psychiatry (46.2%). The majority of respondents (79.3%) indicated that outpatient follow-up should occur within 4 weeks of discharge from the hospital. Conclusions: Headache specialists indicated neuroleptics, NSAID and migraine-specific agents should be considered before opioids or barbiturates for both adults and children with migraine. There was consensus that worsening or refractory migraine treatment should not include the escalation of chronic opioids. Opinion suggested that opioid or barbiturate overuse is more likely to warrant inpatient treatment than triptan or NSAID overuse. Multidisciplinary care and close follow-up are important components of inpatient migraine treatment.

Chronic Daily Headache in Korea: Prevalence, Clinical Characteristics, Medical Consultation and Management

BACKGROUND AND PURPOSE: Chronic daily headache (CDH) is a commonly reported reason for visiting hospital neurology departments, but its prevalence, clinical characteristics, and management have not been well documented in Korea. The objective of this study was to characterize the 1-year prevalence, clinical characteristics, medical consultations, and treatment for CDH in Korea. METHODS: The Korean Headache Survey (KHS) is a nationwide descriptive survey of 1507 Korean adults aged between 19 and 69 years. The KHS investigated headache characteristics, sociodemographics, and headache-related disability using a structured interview. We used the KHS data for this study. RESULTS: The 1-year prevalence of CDH was 1.8% (95% confidence interval, 1.1-2.5%), and 25.7% of the subjects with CDH met the criteria for medication overuse. Two-thirds (66.7%) of CDH subjects were classified as having chronic migraine, and approximately half of the CDH subjects (48.1%) reported that their headaches either substantially or severely affected their quality of life. Less than half (40.7%) of the subjects with CDH reported having consulted a doctor for their headaches and 40.7% had not received treatment for their headaches during the previous year. CONCLUSIONS: The prevalence of CDH was 1.8% and medication overuse was associated with one-quarter of CDH cases in Korea. Many subjects with CDH do not seek medical consultation and do not receive appropriate treatment for their headaches.

Cefaleia e disfunção têmporo-mandibular / Headache and temporo-mandibular dysfunction

A disfunção têmporo-mandibular é uma desordem neuromuscular que se caracteriza pela presença de cefaleia crônica, ruídos na articulação têmporo-mandibular, limitações dos movimentos mandibulares, hiperestesia e dor nos músculos mastigatórios, da cabeça e do pescoço. A cefaleia consiste em qualquer dor localizada no segmento cefálico, sendo a queixa mais comum nos pacientes com disfunção têmporo-mandibular. O presente estudo de revisão da literatura tem por objetivo estabelecer uma correlação entre a presença de disfunção têmporo-mandibular e o tipo de cefaleia predominantemente apresentado por tais pacientes. Dos pacientes que apresentam disfunção têmporo-mandibular, cerca de 70% relatam ter cefaleia e de 21,5% a 51,8% dos pacientes com cefaleia têm sinais e sintomas de disfunção têmporo-mandibular. Aparentemente, a enxaqueca é mais presente em pacientes com disfunção têmporo-mandibular miofascial, enquanto a cefaleia tensional em pacientes com disfunção têmporo-mandibular articular e a cefaleia crônica diária em pacientes com disfunção têmporo-mandibular mista...

Clinical Characteristics and Efficacy of Prophylactic Treatment of Pediatric Chronic Daily Headache / 대한소아신경학회지

PURPOSE: The purpose of this study was to evaluate the clinical characteristics and efficacy of prophylactic treatment of pediatric chronic daily headache (CDH). METHODS: A retrospective medical-record review of patients who underwent the prophylaxis after a diagnosis of CDH was performed. Response to treatment was assessed by the total number of headache days/month. More than 50% reduction of headache frequency was classified as responders. RESULTS: Eighty patients with the diagnosis of CDH were included in the study. CDH was more prevalent in girls than in boys. It was classified into chronic migraine (81.2%), chronic tension-type headache (15.0%), or new-onset persistent daily headache (3.7%). None of the patient fulfilled the diagnostic criteria of hemicrania continua. The mean age of the patients was 11.8+/-1.2 years. The mean number of monthly headache episodes before treatment was 25.5+/-4.4. After prophylactic treatment, headache episodes were reduced to 8.7+/-9.5 episodes per month. The responder rate of prophylactic treatment was 70.2% (55/80 patients) for either topiramate or flunarizine. CONCLUSION: In our study, the most common type of CDH was chronic migraine. All patients with CDH had frequent, long lasting migraine attacks. This study also suggests that prophylactic treatment is effective in the treatment of pediatric CDH.

Patients with sudden onset headache not meeting the criteria of the International Headache Society for new daily persistent headache. How to classify them? / Pacientes com cefaleia persistente e diária desde o início que não preenchem os critérios da International Headache Society. Como classificá-los?

We conducted a retrospective analysis of the records of 1348 patients regularly treated at the headache clinic of Department of Neurology of Santa Casa de São Paulo, Brazil. Sixty-two patients reported history of daily and persistent headache. From the 62 patients selected, only 21 (group 1) could be diagnosed with new daily-persistent headache (NDPH) according to the International Headache Society (HIS) 2004 criteria. The 41 remaining patients (group 2) could not be diagnosed with NDPH according to IHS-2004 once they presented two or more migraine attack-related symptoms, such as: nausea, photophobia, phonophobia and vomiting, in different combinations. It was not possible to classify them in groups 1 to 4 of primary headaches either. How to classify them? We suggest that the criteria are revised. And one way we can classify them, would be the subdivision: NDPH with migraine features and without migraine features that would allow the inclusion of all individuals present who has a daily and persistent headache from the beginning.

Realizamos uma análise retrospectiva do prontuário de 1348 pacientes acompanhados no ambulatório de Cefaleia do Departamento de Neurologia da Santa Casa de São Paulo, Brasil. Sessenta e dois pacientes relataram história de cefaleia persistente e diária (NDPH) desde o início. Destes, apenas 21 (grupo 1) puderam ser diagnosticados com NDPH de acordo com os critérios da Sociedade Internacional de Cefaleia 2004. Os 41 pacientes restantes (grupo 2) não puderam ser diagnosticados como NDPH, uma vez que apresentaram dois ou mais sintomas relacionados a cefaleia do tipo enxaqueca, tais como: náuseas, fotofobia, fonofobia e vômitos, em diferentes combinações. Não foi possível, também, classificá-los entre os grupos de 1 a 4 das cefaleias primárias. Como classificá-los? Sugerimos que os critérios sejam revistos. E uma maneira de podermos classificá-los seria a subdivisão da NDPH em: com características de enxaqueca e sem características de enxaqueca. Isso permitiria a inclusão de todos os indivíduos portadores de uma cefaleia diária e persistente desde o início.

Polymorphism of the Glutamate Transporter Protein EAAT2 and Migraine Transformation into Chronic Daily Headache

BACKGROUND AND PURPOSE: The progression of migraine into chronic daily headache involves multiple risk factors, but the main contributor is not known. Glutamate is the major excitatory neurotransmitter in central sensitization, which is an important process in the pathogenesis of migraine transformation. The glutamate transporter protein excitatory amino acid transporter 2 (EAAT2) is the primary modulator of glutamatergic neurotransmission, and genetic polymorphisms of its gene, EEAT2, have been identified. The aim of this study was to determine the effect of EAAT2 polymorphisms on migraine transformation into chronic daily headache. METHODS: We included 74 migraine patients with episodic attack (M-E) and 59 migraine patients with chronic daily headache (M-CDH). After amplifying EAAT2 by polymerase chain reaction, we assessed its genotype frequencies based on restriction fragment length polymorphisms. We reclassified all migraine patients into two groups according to their EAAT2 genotype, either with the A allele (n=62) or without it (n=71), and compared the clinical variables between the two groups. RESULTS: The genotype frequencies of EAAT2 polymorphisms did not differ between the M-E and M-CDH groups. Comparison between EEAT2 genotypes revealed that the frequency of analgesic usage was significantly higher among migraine patients with the A allele (12.9+/-1.6 days/month) than in those without the A allele (8.1+/-1.2 days/month; p=0.019). The other clinical variables of migraine did not differ between the two groups. CONCLUSIONS: The results suggest that EEAT2 polymorphism contributes to the tendency toward frequent analgesic usage in migraine patients. This implies a potential genetic influence on the progression of migraine into chronic daily headache through the development of medication-overuse headache.

Cefaleia crônica diária / Chronic daily headache

A cefaleia crônica diária (CCD) compreende quadros de dor de cabeça com duração superior a 15 dias ao mês por, pelo menos, três meses. Não se trata de um diagnóstico etiológico, mas de uma síndrome que representa a principal demanda por atendimento neurológico em centros especializados em cefaleia. As três principais causas de CCD são: migrânea crônica, cefaleia do tipo tensional crônica e cefaleia por abuso de medicamentos. Neste artigo serão abordados os aspectos clínicos e terapêuticos relacionados à abordagem dos pacientes que apresentam cefaleia diária ou quase diária.

Chronic daily headache: stress and impact on the quality of life

OBJECTIVE: To evaluate the stress presence and its influence in the quality of life of patients with chronic daily headache (CDH). METHOD: A hundred patients with at least 18 years old, with primary headache with duration greater than 4 hours a day, and frequency of 15 or more days monthly for at least three months were studied. Lipp's Inventory of Stress Symptoms and the Medical Outcomes Study Short Form (SF-36) were used. RESULTS: Stress was observed in 90 percent of the patients; nearly half of them was in the phase almost exhaustion. Patients with stress when compared with the ones with no stress presented significantly lower scores in all the domains of SF-36; except in physical functioning. The resistance phase presented scores significantly higher than almost exhaustion; except for bodily pain. CONCLUSION: The majority of the patients presented stress with significant reduction in their quality of life. Consequently, the stress could be related with both the development and the maintenance of CDH.

OBJETIVO: Avaliar a presença de estresse e sua influência na qualidade de vida dos pacientes com cefaléia crônica diária (CCD). MÉTODO: Foram estudados 100 pacientes com idade mínima de 18 anos, apresentando cefaléia primária com duração maior que 4 horas e freqüência de 15 ou mais dias por mês, há pelo menos três meses. Foram aplicados o Inventário de Sintomas de Estresse de Lipp e o Questionário SF-36 de Pesquisa em Saúde (SF-36). RESULTADOS: Estresse foi observado em 90 por cento dos pacientes; aproximadamente metade deles estava na fase de quase exaustão. Pacientes com estresse comparados àqueles sem estresse, apresentaram pontuações significativamente menores em todas as escalas do SF-36; exceto em capacidade funcional. A fase de resistência apresentou pontuações significativamente maiores que quase exaustão; exceto para dor corporal. CONCLUSÃO: A grande maioria dos pacientes apresentou estresse com redução significativa na qualidade de vida. Consequentemente, o estresse poderia estar relacionado tanto no desenvolvimento como na manutenção da CCD.

A Case of Chronic Daily Headache Attributed to Hashimoto's Thyroiditis / 대한소아신경학회지

We present a case of Hashimoto's thyroiditis accompanied by chronic daily headache which was relieved by levothyroxine therapy. A 12-year-old girl was referred to our hospital complaining of continuous, bilateral, and non-pulsatile headache which had begun 9 months before. After 2 weeks of appropriate levothyroxine therapy, headache markedly improved. After 4 months of follow-up, she had no new episode of headache.

Clinical Charateristics of Chronic Daily Headache Patients Visit to University Hospital

BACKGROUND: Chronic daily headache(CDH) could be included all of the primary headache disorders with daily or near-daily headache lasting more than 4 hours/day for 15 days/month. Several studies have shown that patients with CDH are difficult to classify using the currently published International Headache Society(HIS) system. Recently, some authors recommended that CDH could be subclassified into transformed migraine(TM), chronic tension-type headache(CTTH), new daily persistent headache(NDPH) and hemicrania continua(HC). METHODS: We analysed 100 patients with CDH who were diagnosed in Taegu-Hyosung Catholic University Hospital from February 1996 to May 1998. To describe clinical features of CDH, we used our CDH protocol. RESULTS: (1) Most of the patients were in their 5th-7th decades, and female was predominantly affected(female to male ratio, 7.3:1). (2) The subclassification of CDH were CTTH in 59 patients, TM in 33 patients, NDPH in 7 patients, and HC in 1 patient. (3) Clinical characteristics of CDH were mostly bilateral location, mild to moderate intensity and dull nature. The mean onset age of CDH was 47.7 years, the onset time of the day was in the afternoon or anytime, the duration was more than 4 hours or 12 hours in 90 patients, and the frequency was near-daily or daily in 80 patients. Common associated symptoms were nausea, dizziness, insomnia, fatigue, photophobia, blurred vision, and scalp tenderness. (4) Daily use of analgesics was reported in 66 patients. CDH was aggravated during premenstrual period in 10 patients. Positive family history was shown in 26 patients. CONCLUSIONS: We present this report because knowledge of clinical characteristics and adequate protocol for CDH in clinical practice is necessary.