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Carvalho LCLS, da Silva PA, Rocha-Filho PAS. Persistent headache and chronic daily headache after COVID-19: a prospective cohort study. Korean J Pain 2024; 37:247-255. [PMID: 38881283 PMCID: PMC11220374 DOI: 10.3344/kjp.24046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 06/18/2024] Open
Abstract
Background Little is known about the frequency and impact of the persistent headache and about the incidence of chronic daily headache (CDH) after coronavirus disease 2019 (COVID-19). The aim of this prospective cohort study was to assess the incidence, risk factors, characteristics, and impact of CDH in patients with COVID-19. Methods In the first stage, 288 patients were interviewed by telephone after the acute phase of COVID-19. Subsequently, 199 patients who presented headache were reinterviewed at least one year after COVID-19. Headaches that persisted beyond the acute phase of COVID-19 for three or more months and presented frequency ≥ 45 days over the first three months were considered to be CDH. Results One hundred and twenty-three patients were included, 56% were females; median age: 50 years (25th and 75th percentile: 41;58). The headache persisted beyond the acute phase of COVID-19 in 52%, and 20.3% had CDH (95% confidence interval: 13.6-28.2). Individuals who previously had headaches and who had headaches of greater intensity during the acute phase were at higher risk of developing CDH. The group with CDH included more females, greater impact of headache, more persistence of headache beyond the 120th day of COVID-19 and less throbbing headache than did the other individuals whose headache persisted. Conclusions Patients who had COVID-19 had a high incidence of CDH. Previous headache and greater intensity of headache were associated with higher risk of CDH.
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Affiliation(s)
| | - Priscila Aparecida da Silva
- Scientific Initiation Fellowships Institutional Program (CNPq/PROPESQI-UFPE), Centro de Ciências Médicas, Universidade Federal de Pernambuco (UFPE), Recife, Brazil
| | - Pedro Augusto Sampaio Rocha-Filho
- Hospital Universitario Oswaldo Cruz, Universidade de Pernambuco (UPE), Recife, Brazil
- Division of Neuropsychiatry, Centro de Ciências Médicas, Universidade Federal de Pernambuco (UFPE), Recife, Brazil
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2
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Dhiman NR, Joshi D, Singh R, Gyanpuri V, Kumar A. Post-COVID-19 headache- NDPH phenotype: a systematic review of case reports. FRONTIERS IN PAIN RESEARCH 2024; 5:1376506. [PMID: 38808005 PMCID: PMC11130372 DOI: 10.3389/fpain.2024.1376506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 04/26/2024] [Indexed: 05/30/2024] Open
Abstract
Background and objectives Post-acute COVID-19 syndrome or "long COVID" affects patients even after the recovery from Covid infection in various ways. Persistent headache or New Daily Persistent Headache (NDPH) is one of such symptoms. In this review, we will discuss about the case-reports of post covid-19 headache- NDPH phenotype both after and in the course of COVID-19 infection. Methods Case reports/studies talked about patients having NDPH around the disease either immediately or late post COVID were included. Data was taken from the source and synthesised on a qualitative basis. Results Literature search showed 3,538 articles, out of which 12 were screened as per the eligibility criteria and finally, 4 case reports on NDPH and Covid-19 were chosen for analysis from the database and by human search. All case reports justify the criteria for acceptability in quality for this systematic review. Conclusion NDPH in and around Covid 19 infection is something that is currently an ingenious debated topic in the scientific community. More case studies should be written and published on the same subject so that a large systematic review could be conducted. Trial Registration Information The review is registered in Prospero with no. Identifier (CRD42022354912). Systematic Review Registration https://www.crd.york.ac.uk/, PROSPERO (CRD42022354912).
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Affiliation(s)
| | - Deepika Joshi
- Department of Neurology, Banaras Hindu University, Varanasi, India
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3
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Boezaart AP, Smith CR, Zasimovich Y, Przkora R, Kumar S, Nin OC, Boezaart LC, Botha DA, Leonard A, Reina MA, Pareja JA. Refractory primary and secondary headache disorders that dramatically responded to combined treatment of ultrasound-guided percutaneous suprazygomatic pterygopalatine ganglion blocks and non-invasive vagus nerve stimulation: a case series. Reg Anesth Pain Med 2024; 49:144-150. [PMID: 37989499 DOI: 10.1136/rapm-2023-104967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/06/2023] [Indexed: 11/23/2023]
Abstract
In 1981, Devoghel achieved an 85.6% success rate in treating patients with treatment-refractory cluster headaches with alcoholization of the pterygopalatine ganglion (PPG) via the percutaneous suprazygomatic approach. Devoghel's study led to the theory that interrupting the parasympathetic pathway by blocking its transduction at the PPG could prevent or treat symptoms related to primary headache disorders (PHDs). Furthermore, non-invasive vagus nerve stimulation (nVNS) has proven to treat PHDs and has been approved by national regulatory bodies to treat, among others, cluster headaches and migraines.In this case series, nine desperate patients who presented with 11 longstanding treatment-refractory primary headache disorders and epidural blood patch-resistant postdural puncture headache (PDPH) received ultrasound-guided percutaneous suprazygomatic pterygopalatine ganglion blocks (PPGB), and seven also received nVNS. The patients were randomly selected and were not part of a research study. They experienced dramatic, immediate, satisfactory, and apparently lasting symptom resolution (at the time of the writing of this report). The report provides the case descriptions, briefly reviews the trigeminovascular and neurogenic inflammatory theories of the pathophysiology, outlines aspects of these PPGB and nVNS interventions, and argues for adopting this treatment regime as a first-line or second-line treatment rather than desperate last-line treatment of PDPH and PHDs.
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Affiliation(s)
- Andre P Boezaart
- Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
- Lumina Health, Surrey, UK
| | - Cameron R Smith
- Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Yury Zasimovich
- Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Rene Przkora
- Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Sanjeev Kumar
- Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Olga C Nin
- Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | | | | | - André Leonard
- Private Neurology Practice, Mossel Bay, South Africa
| | - Miguel A Reina
- Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
- Anesthesiology, CEU San Pablo University Faculty of Medicine, Madrid, Spain
| | - Juan A Pareja
- Neurology, Hospital Universitario Quirón Madrid, Madrid, Spain
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4
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Atalar AÇ, Genç H, Ur Özçelik E, Bolay H, Uluduz D, Unal-Cevik, Kissani N, Luvsannorov O, Togha M, Ozge A, Baykan B. Other primary headache disorders: Data from the HEAD-MENA-A study in Africa, Asia, and the Middle East. Clin Neurol Neurosurg 2024; 236:108112. [PMID: 38232607 DOI: 10.1016/j.clineuro.2023.108112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 12/22/2023] [Accepted: 12/29/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVE Other primary headache disorders (OPHD) are under-investigated compared to frequent primary headache types like migraine, tension-type headache, and trigeminal autonomic cephalalgias. Knowledge of the distribution and characteristics of OPHD subtypes is crucial for their recognition. We aimed to determine the prevalence at the hospital and headache clinics and clinical characteristics of OPHDs in patients from 13 countries. METHODS We analyzed a large dataset from the cross-sectional study Head-MENA-A (Middle East, North Africa, Asia). Consecutive patients over 10 years of age presenting with headaches were included from outpatient, inpatient, and emergency settings. A structured questionnaire addressing demographics, headache characteristics, accompanying symptoms, and triggers was administered. Headache subtypes were diagnosed according to the ICHD-3 criteria. RESULTS Among patients complaining of headaches (n = 3722), 106 (2.9%) were diagnosed with OPHD. Fifty-two patients (1.4% of all headache patients) had only OPHD, while 54 (1.5%) had both OPHD and a co-existing primary headache (mostly migraine). All OPHDs were more common in females. The most frequent subtypes were new daily persistent headache and primary stabbing headache (0.2% each among all admitted patients). Photophobia and phonophobia were the most frequent accompanying symptoms, while physical activity (28.8%), stress (15.4%), and the Valsalva maneuver (15.4%) were the most common triggering factors. The majority of triggering factors were more pronounced in patients with both migraine and OPHD. CONCLUSIONS Other primary headaches are rare and heterogeneous. Their high co-existence with migraine suggests shared predisposing factors, hinting at a "headache continuum" concept for primary headaches.
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Affiliation(s)
- A Ç Atalar
- Health Sciences University, Kanuni Sultan Süleyman Education and Research Hospital, Department of Neurology, Istanbul, Turkiye.
| | - H Genç
- University of Health Sciences, Van Training and Research Hospital, Van, Turkiye
| | - E Ur Özçelik
- Health Sciences University, Kanuni Sultan Süleyman Education and Research Hospital, Department of Neurology, Istanbul, Turkiye
| | - H Bolay
- Gazi University, Medical Faculty, Department of Neurology and Algology, NOROM, Ankara, Turkiye
| | - D Uluduz
- Istanbul University-Cerrahpaşa, Medical Faculty, Department of Neurology, Istanbul, Turkiye
| | - Unal-Cevik
- Hacettepe University, Medical Faculty, Department of Neurology, Ankara, Turkiye
| | - N Kissani
- Neuroscience Research Laboratory in Marrakech Medical School, Cadi Ayyad University, Marrakech, Morocco
| | - O Luvsannorov
- Mongolian National University of Medical Sciences, Department of Neurology, Ulaanbaatar, Mongolia
| | - M Togha
- Tehran University of Medical Sciences, School of Medicine, Department of Neurology, Tehran, Iran
| | - A Ozge
- Mersin University, Medical Faculty, Department of Neurology, Mersin, Turkiye
| | - B Baykan
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkiye; EMAR Medical Center, Istanbul, Turkiye
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Sadeghpour M, Abdolizadeh A, Yousefi P, Rastegar-Kashkouli A, Chitsaz A. New Daily Persistent Headache (NDPH): Unraveling the Complexities of Diagnosis, Pathophysiology, and Treatment. Curr Pain Headache Rep 2023; 27:551-559. [PMID: 37632682 DOI: 10.1007/s11916-023-01161-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 08/28/2023]
Abstract
PURPOSE OF REVIEW The current article aims to provide an overview of new daily persistent headache (NDPH), with a particular emphasis on its pathophysiology, evaluation, and current treatment options. RECENT FINDINGS NDPH is an uncommon and heterogeneous condition associated with various comorbidities and is of great significance due to its prolonged duration and high severity. Variable causes and clinical aspects of NDPH may reflect differences in its underlying pathophysiological mechanisms, including genetics, environmental triggers, neuroinflammation, and brain changes. When assessing a patient with NDPH, potential triggers, past medical history, and differential diagnosis should be carefully considered. Non-pharmacological interventions aimed to improve diet, sleep patterns, and reduce consumption of caffeine and alcohol are recommended for all patients. Nerve blockade and nerve stimulation seem to be more efficacious in children than adults. Antiviral medications and neuroinflammation-targeting treatments may be helpful, particularly, when an infectious disease or severe inflammation is suspected. NDPH patients with concurrent affective disorders may benefit from treatment with serotonin reuptake inhibitors, serotonin/norepinephrine reuptake inhibitors, or benzodiazepines. Cerebrospinal-fluid-lowering medications may be useful for headaches started with a thunderclap or a Valsalva maneuver. Possible treatments for refractory NDPH include intravenous ketamine or lidocaine, onabotulinumtoxinA, and calcitonin gene-related peptide antibodies. Considering the variety of NDPH, it is critical to properly screen patients for correct diagnosis. Proper identification of potential mimics may enable precise therapy opportunities, yet there is no gold standard treatment for NDPH. Further well-designed studies are needed to elucidate the underlying mechanisms and develop effective treatment strategies for NDPH.
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Affiliation(s)
- Majid Sadeghpour
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Abdolizadeh
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Pourya Yousefi
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Ahmad Chitsaz
- Department of Neurology, Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
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Wang W, Yuan Z, Zhang X, Bai X, Tang H, Mei Y, Qiu D, Zhang Y, Zhang P, Zhang X, Zhang Y, Yu X, Sui B, Wang Y. Mapping the aberrant brain functional connectivity in new daily persistent headache: a resting-state functional magnetic resonance imaging study. J Headache Pain 2023; 24:46. [PMID: 37098469 PMCID: PMC10131335 DOI: 10.1186/s10194-023-01577-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/13/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND AND PURPOSE The pathogenesis of new daily persistent headache (NDPH) is not fully understood. We aim to map aberrant functional connectivity (FC) in patients with NDPH using resting-state functional magnetic resonance imaging (MRI). METHODS Brain structural and functional MRI data were acquired from 29 patients with NDPH and 37 well-matched healthy controls (HCs) in this cross-sectional study. Region of interest (ROI) based analysis was used to compare FC between patients and HCs, with 116 brain regions in the automated anatomical labeling (AAL) atlas were defined as seeds. The correlations between aberrant FC and patients' clinical characteristics, and neuropsychological evaluation were also investigated. RESULTS Compared with HCs, patients with NDPH showed increased FC in the left inferior occipital gyrus, right thalamus and decreased FC in right lingual gyrus, left superior occipital gyrus, right middle occipital gyrus, left inferior occipital gyrus, right inferior occipital gyrus, right fusiform gyrus, left postcentral gyrus, right postcentral gyrus, right thalamus and right superior temporal gyrus. There were no correlation between FC of these brain regions and clinical characteristics, neuropsychological evaluation after Bonferroni correction (p > 0.05/266). CONCLUSIONS Patients with NDPH showed aberrant FC in multiple brain regions involved in perception and regulation of emotion and pain. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05334927.
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Affiliation(s)
- Wei Wang
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Ziyu Yuan
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Xueyan Zhang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
| | - Xiaoyan Bai
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing Neurosurgical Institute, Beijing, 100070, China
| | - Hefei Tang
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Yanliang Mei
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Dong Qiu
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Yingkui Zhang
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
| | - Peng Zhang
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Xue Zhang
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing Neurosurgical Institute, Beijing, 100070, China
| | - Yaqing Zhang
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Xueying Yu
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Binbin Sui
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China.
| | - Yonggang Wang
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
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Rubino E, Marcinnò A, Grassini A, Piella EM, Ferrandes F, Roveta F, Boschi S, Cermelli A, Gallone S, Savi L, Rainero I. Polymorphisms of the Proinflammatory Cytokine Genes Modulate the Response to NSAIDs but Not to Triptans in Migraine Attacks. Int J Mol Sci 2022; 24:ijms24010657. [PMID: 36614097 PMCID: PMC9820603 DOI: 10.3390/ijms24010657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/21/2022] [Accepted: 12/26/2022] [Indexed: 01/03/2023] Open
Abstract
Migraine is a common neurovascular disorder characterized by recurrent episodes of headache and associated neurological symptoms. At present, a significant portion of patients do not obtain a satisfactory response to acute pain-relieving therapies, including NSAIDs and triptans. In this context, pharmacogenetics plays a key role in the understanding of such a diverse response. In order to investigate whether functional polymorphisms in proinflammatory cytokine genes (IL-1α, IL-1β, IL-1RN; IL-6 and TNF-α) may influence the response to acute treatment, 313 consecutive patients with episodic migraine without aura were enrolled. Pain relief by administration of NSAIDs or triptans for three consecutive migraine attacks was evaluated. We found a significant association between A allele of the TNF-α promoter (−308 A/G) and a lack of efficacy after NSAID administration (p < 0.01, OR 2.51, 95% CI: 1.33 < OR < 4.75 compared to the G allele). Remaining polymorphisms had no significant effect on pain relief. Our study showed that a functional polymorphism in the TNF-α gene significantly modulates the clinical response to NSAID administration in acute attacks. Patients with higher production of the active cytokine during stress showed a significantly lower anti-migraine effect. Our results further support a role for TNF-α in the pathophysiological mechanisms of migraine attack.
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Affiliation(s)
- Elisa Rubino
- Department of Neurosciences “Rita Levi Montalcini”, University of Torino, 10126 Torino, Italy
- Department of Neuroscience and Mental Health, Città della Salute e della Scienza di Torino, 10126 Torino, Italy
- Correspondence:
| | - Andrea Marcinnò
- Department of Neurosciences “Rita Levi Montalcini”, University of Torino, 10126 Torino, Italy
| | - Alberto Grassini
- Department of Neurosciences “Rita Levi Montalcini”, University of Torino, 10126 Torino, Italy
| | - Elisa Maria Piella
- Department of Neurosciences “Rita Levi Montalcini”, University of Torino, 10126 Torino, Italy
| | - Fabio Ferrandes
- Department of Neurosciences “Rita Levi Montalcini”, University of Torino, 10126 Torino, Italy
| | - Fausto Roveta
- Department of Neurosciences “Rita Levi Montalcini”, University of Torino, 10126 Torino, Italy
| | - Silvia Boschi
- Department of Neurosciences “Rita Levi Montalcini”, University of Torino, 10126 Torino, Italy
| | - Aurora Cermelli
- Department of Neurosciences “Rita Levi Montalcini”, University of Torino, 10126 Torino, Italy
| | - Salvatore Gallone
- Department of Neuroscience and Mental Health, Città della Salute e della Scienza di Torino, 10126 Torino, Italy
| | - Lidia Savi
- Department of Neuroscience and Mental Health, Città della Salute e della Scienza di Torino, 10126 Torino, Italy
| | - Innocenzo Rainero
- Department of Neurosciences “Rita Levi Montalcini”, University of Torino, 10126 Torino, Italy
- Department of Neuroscience and Mental Health, Città della Salute e della Scienza di Torino, 10126 Torino, Italy
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Begasse de Dhaem O, Rizzoli P. Refractory Headaches. Semin Neurol 2022; 42:512-522. [DOI: 10.1055/s-0042-1757925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractMedication overuse headache (MOH), new daily persistent headache (NDPH), and persistent refractory headache attributed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection represent a significant burden in terms of disability and quality of life, and a challenge in terms of definition, pathophysiology, and treatment. Regarding MOH, prevention without withdrawal is not inferior to prevention with withdrawal. Preventive medications like topiramate, onabotulinumtoxinA, and calcitonin gene-related peptide (CGRP) monoclonal antibodies improve chronic migraine with MOH regardless of withdrawal. The differential diagnosis of NDPH is broad and should be carefully examined. There are no guidelines for the treatment of NDPH, but options include a short course of steroids, nerve blocks, topiramate, nortriptyline, gabapentin, CGRP monoclonal antibodies, and onabotulinumtoxinA. The persistence of headache 3 months after SARS-CoV2 infection is a predictor of poor prognosis.
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Affiliation(s)
- Olivia Begasse de Dhaem
- Headache Specialist at Hartford HealthCare, Hartford, Connecticut
- Department of Neurology at the University of Connecticut, Milford, Connecticut
| | - Paul Rizzoli
- Department of Neurology, Brigham and Women's Faulkner Hospital J Graham Headache Center, Boston, Massachusetts
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