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Callen AL, Friedman DI, Parikh S, Rau JC, Schievink WI, Cutsforth-Gregory JK, Amrhein TJ, Haight E, Cowan RP, Barad MJ, Hah JM, Jackson T, Deline C, Buchanan AJ, Carroll I. Diagnosis and Treatment of Spontaneous Intracranial Hypotension: Role of Epidural Blood Patching. Neurol Clin Pract 2024; 14:e200290. [PMID: 38699599 PMCID: PMC11065326 DOI: 10.1212/cpj.0000000000200290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/23/2024] [Indexed: 05/05/2024]
Abstract
Purpose of Review This review focuses on the challenges of diagnosing and treating spontaneous intracranial hypotension (SIH), a condition caused by spinal CSF leakage. It emphasizes the need for increased awareness and advocates for early and thoughtful use of empirical epidural blood patches (EBPs) in suspected cases. Recent Findings SIH diagnosis is hindered by variable symptoms and inconsistent imaging results, including normal brain MRI and unreliable spinal opening pressures. It is crucial to consider SIH in differential diagnoses, especially in patients with connective tissue disorders. Early EBP intervention is shown to improve outcomes. Summary SIH remains underdiagnosed and undertreated, requiring heightened awareness and understanding. This review promotes proactive EBP use in managing suspected SIH and calls for continued research to advance diagnostic and treatment methods, emphasizing the need for innovative imaging techniques for accurate diagnosis and timely intervention.
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Affiliation(s)
- Andrew L Callen
- Department of Radiology (ALC), University of Colorado Anschutz Medical Campus, Denver; Yellow Rose Headache and Neurology-Ophthalmology (DIF), Dallas, TX; Department of Neurology (SP), Thomas Jefferson University, Philadelphia, PA; Bob Bove Neuroscience Institute (JCR), HonorHealth Neurology, Scottsdale, AZ; Department of Neurosurgery (WIS), Cedars Sinai Medical Center, Beverly Hills, CA; Department of Neurology (JKC-G), Mayo Clinic, Rochester, MN; Department of Radiology (TJA), Duke University, Durham, NC; Department of Anesthesia (EH), UCSF, San Francisco, CA; Departments of Neurology (RPC, MJB) and Anesthesiology (JMH, IC), Stanford University, Stanford, CA; Opos Solutions (TJ), San Mateo, CA; and Spinal CSF Leak Foundation (CD, AJB), Spokane, WA
| | - Deborah I Friedman
- Department of Radiology (ALC), University of Colorado Anschutz Medical Campus, Denver; Yellow Rose Headache and Neurology-Ophthalmology (DIF), Dallas, TX; Department of Neurology (SP), Thomas Jefferson University, Philadelphia, PA; Bob Bove Neuroscience Institute (JCR), HonorHealth Neurology, Scottsdale, AZ; Department of Neurosurgery (WIS), Cedars Sinai Medical Center, Beverly Hills, CA; Department of Neurology (JKC-G), Mayo Clinic, Rochester, MN; Department of Radiology (TJA), Duke University, Durham, NC; Department of Anesthesia (EH), UCSF, San Francisco, CA; Departments of Neurology (RPC, MJB) and Anesthesiology (JMH, IC), Stanford University, Stanford, CA; Opos Solutions (TJ), San Mateo, CA; and Spinal CSF Leak Foundation (CD, AJB), Spokane, WA
| | - Simy Parikh
- Department of Radiology (ALC), University of Colorado Anschutz Medical Campus, Denver; Yellow Rose Headache and Neurology-Ophthalmology (DIF), Dallas, TX; Department of Neurology (SP), Thomas Jefferson University, Philadelphia, PA; Bob Bove Neuroscience Institute (JCR), HonorHealth Neurology, Scottsdale, AZ; Department of Neurosurgery (WIS), Cedars Sinai Medical Center, Beverly Hills, CA; Department of Neurology (JKC-G), Mayo Clinic, Rochester, MN; Department of Radiology (TJA), Duke University, Durham, NC; Department of Anesthesia (EH), UCSF, San Francisco, CA; Departments of Neurology (RPC, MJB) and Anesthesiology (JMH, IC), Stanford University, Stanford, CA; Opos Solutions (TJ), San Mateo, CA; and Spinal CSF Leak Foundation (CD, AJB), Spokane, WA
| | - Jill C Rau
- Department of Radiology (ALC), University of Colorado Anschutz Medical Campus, Denver; Yellow Rose Headache and Neurology-Ophthalmology (DIF), Dallas, TX; Department of Neurology (SP), Thomas Jefferson University, Philadelphia, PA; Bob Bove Neuroscience Institute (JCR), HonorHealth Neurology, Scottsdale, AZ; Department of Neurosurgery (WIS), Cedars Sinai Medical Center, Beverly Hills, CA; Department of Neurology (JKC-G), Mayo Clinic, Rochester, MN; Department of Radiology (TJA), Duke University, Durham, NC; Department of Anesthesia (EH), UCSF, San Francisco, CA; Departments of Neurology (RPC, MJB) and Anesthesiology (JMH, IC), Stanford University, Stanford, CA; Opos Solutions (TJ), San Mateo, CA; and Spinal CSF Leak Foundation (CD, AJB), Spokane, WA
| | - Wouter I Schievink
- Department of Radiology (ALC), University of Colorado Anschutz Medical Campus, Denver; Yellow Rose Headache and Neurology-Ophthalmology (DIF), Dallas, TX; Department of Neurology (SP), Thomas Jefferson University, Philadelphia, PA; Bob Bove Neuroscience Institute (JCR), HonorHealth Neurology, Scottsdale, AZ; Department of Neurosurgery (WIS), Cedars Sinai Medical Center, Beverly Hills, CA; Department of Neurology (JKC-G), Mayo Clinic, Rochester, MN; Department of Radiology (TJA), Duke University, Durham, NC; Department of Anesthesia (EH), UCSF, San Francisco, CA; Departments of Neurology (RPC, MJB) and Anesthesiology (JMH, IC), Stanford University, Stanford, CA; Opos Solutions (TJ), San Mateo, CA; and Spinal CSF Leak Foundation (CD, AJB), Spokane, WA
| | - Jeremy K Cutsforth-Gregory
- Department of Radiology (ALC), University of Colorado Anschutz Medical Campus, Denver; Yellow Rose Headache and Neurology-Ophthalmology (DIF), Dallas, TX; Department of Neurology (SP), Thomas Jefferson University, Philadelphia, PA; Bob Bove Neuroscience Institute (JCR), HonorHealth Neurology, Scottsdale, AZ; Department of Neurosurgery (WIS), Cedars Sinai Medical Center, Beverly Hills, CA; Department of Neurology (JKC-G), Mayo Clinic, Rochester, MN; Department of Radiology (TJA), Duke University, Durham, NC; Department of Anesthesia (EH), UCSF, San Francisco, CA; Departments of Neurology (RPC, MJB) and Anesthesiology (JMH, IC), Stanford University, Stanford, CA; Opos Solutions (TJ), San Mateo, CA; and Spinal CSF Leak Foundation (CD, AJB), Spokane, WA
| | - Timothy J Amrhein
- Department of Radiology (ALC), University of Colorado Anschutz Medical Campus, Denver; Yellow Rose Headache and Neurology-Ophthalmology (DIF), Dallas, TX; Department of Neurology (SP), Thomas Jefferson University, Philadelphia, PA; Bob Bove Neuroscience Institute (JCR), HonorHealth Neurology, Scottsdale, AZ; Department of Neurosurgery (WIS), Cedars Sinai Medical Center, Beverly Hills, CA; Department of Neurology (JKC-G), Mayo Clinic, Rochester, MN; Department of Radiology (TJA), Duke University, Durham, NC; Department of Anesthesia (EH), UCSF, San Francisco, CA; Departments of Neurology (RPC, MJB) and Anesthesiology (JMH, IC), Stanford University, Stanford, CA; Opos Solutions (TJ), San Mateo, CA; and Spinal CSF Leak Foundation (CD, AJB), Spokane, WA
| | - Elena Haight
- Department of Radiology (ALC), University of Colorado Anschutz Medical Campus, Denver; Yellow Rose Headache and Neurology-Ophthalmology (DIF), Dallas, TX; Department of Neurology (SP), Thomas Jefferson University, Philadelphia, PA; Bob Bove Neuroscience Institute (JCR), HonorHealth Neurology, Scottsdale, AZ; Department of Neurosurgery (WIS), Cedars Sinai Medical Center, Beverly Hills, CA; Department of Neurology (JKC-G), Mayo Clinic, Rochester, MN; Department of Radiology (TJA), Duke University, Durham, NC; Department of Anesthesia (EH), UCSF, San Francisco, CA; Departments of Neurology (RPC, MJB) and Anesthesiology (JMH, IC), Stanford University, Stanford, CA; Opos Solutions (TJ), San Mateo, CA; and Spinal CSF Leak Foundation (CD, AJB), Spokane, WA
| | - Robert P Cowan
- Department of Radiology (ALC), University of Colorado Anschutz Medical Campus, Denver; Yellow Rose Headache and Neurology-Ophthalmology (DIF), Dallas, TX; Department of Neurology (SP), Thomas Jefferson University, Philadelphia, PA; Bob Bove Neuroscience Institute (JCR), HonorHealth Neurology, Scottsdale, AZ; Department of Neurosurgery (WIS), Cedars Sinai Medical Center, Beverly Hills, CA; Department of Neurology (JKC-G), Mayo Clinic, Rochester, MN; Department of Radiology (TJA), Duke University, Durham, NC; Department of Anesthesia (EH), UCSF, San Francisco, CA; Departments of Neurology (RPC, MJB) and Anesthesiology (JMH, IC), Stanford University, Stanford, CA; Opos Solutions (TJ), San Mateo, CA; and Spinal CSF Leak Foundation (CD, AJB), Spokane, WA
| | - Meredith J Barad
- Department of Radiology (ALC), University of Colorado Anschutz Medical Campus, Denver; Yellow Rose Headache and Neurology-Ophthalmology (DIF), Dallas, TX; Department of Neurology (SP), Thomas Jefferson University, Philadelphia, PA; Bob Bove Neuroscience Institute (JCR), HonorHealth Neurology, Scottsdale, AZ; Department of Neurosurgery (WIS), Cedars Sinai Medical Center, Beverly Hills, CA; Department of Neurology (JKC-G), Mayo Clinic, Rochester, MN; Department of Radiology (TJA), Duke University, Durham, NC; Department of Anesthesia (EH), UCSF, San Francisco, CA; Departments of Neurology (RPC, MJB) and Anesthesiology (JMH, IC), Stanford University, Stanford, CA; Opos Solutions (TJ), San Mateo, CA; and Spinal CSF Leak Foundation (CD, AJB), Spokane, WA
| | - Jennifer M Hah
- Department of Radiology (ALC), University of Colorado Anschutz Medical Campus, Denver; Yellow Rose Headache and Neurology-Ophthalmology (DIF), Dallas, TX; Department of Neurology (SP), Thomas Jefferson University, Philadelphia, PA; Bob Bove Neuroscience Institute (JCR), HonorHealth Neurology, Scottsdale, AZ; Department of Neurosurgery (WIS), Cedars Sinai Medical Center, Beverly Hills, CA; Department of Neurology (JKC-G), Mayo Clinic, Rochester, MN; Department of Radiology (TJA), Duke University, Durham, NC; Department of Anesthesia (EH), UCSF, San Francisco, CA; Departments of Neurology (RPC, MJB) and Anesthesiology (JMH, IC), Stanford University, Stanford, CA; Opos Solutions (TJ), San Mateo, CA; and Spinal CSF Leak Foundation (CD, AJB), Spokane, WA
| | - Tracy Jackson
- Department of Radiology (ALC), University of Colorado Anschutz Medical Campus, Denver; Yellow Rose Headache and Neurology-Ophthalmology (DIF), Dallas, TX; Department of Neurology (SP), Thomas Jefferson University, Philadelphia, PA; Bob Bove Neuroscience Institute (JCR), HonorHealth Neurology, Scottsdale, AZ; Department of Neurosurgery (WIS), Cedars Sinai Medical Center, Beverly Hills, CA; Department of Neurology (JKC-G), Mayo Clinic, Rochester, MN; Department of Radiology (TJA), Duke University, Durham, NC; Department of Anesthesia (EH), UCSF, San Francisco, CA; Departments of Neurology (RPC, MJB) and Anesthesiology (JMH, IC), Stanford University, Stanford, CA; Opos Solutions (TJ), San Mateo, CA; and Spinal CSF Leak Foundation (CD, AJB), Spokane, WA
| | - Connie Deline
- Department of Radiology (ALC), University of Colorado Anschutz Medical Campus, Denver; Yellow Rose Headache and Neurology-Ophthalmology (DIF), Dallas, TX; Department of Neurology (SP), Thomas Jefferson University, Philadelphia, PA; Bob Bove Neuroscience Institute (JCR), HonorHealth Neurology, Scottsdale, AZ; Department of Neurosurgery (WIS), Cedars Sinai Medical Center, Beverly Hills, CA; Department of Neurology (JKC-G), Mayo Clinic, Rochester, MN; Department of Radiology (TJA), Duke University, Durham, NC; Department of Anesthesia (EH), UCSF, San Francisco, CA; Departments of Neurology (RPC, MJB) and Anesthesiology (JMH, IC), Stanford University, Stanford, CA; Opos Solutions (TJ), San Mateo, CA; and Spinal CSF Leak Foundation (CD, AJB), Spokane, WA
| | - Andrea J Buchanan
- Department of Radiology (ALC), University of Colorado Anschutz Medical Campus, Denver; Yellow Rose Headache and Neurology-Ophthalmology (DIF), Dallas, TX; Department of Neurology (SP), Thomas Jefferson University, Philadelphia, PA; Bob Bove Neuroscience Institute (JCR), HonorHealth Neurology, Scottsdale, AZ; Department of Neurosurgery (WIS), Cedars Sinai Medical Center, Beverly Hills, CA; Department of Neurology (JKC-G), Mayo Clinic, Rochester, MN; Department of Radiology (TJA), Duke University, Durham, NC; Department of Anesthesia (EH), UCSF, San Francisco, CA; Departments of Neurology (RPC, MJB) and Anesthesiology (JMH, IC), Stanford University, Stanford, CA; Opos Solutions (TJ), San Mateo, CA; and Spinal CSF Leak Foundation (CD, AJB), Spokane, WA
| | - Ian Carroll
- Department of Radiology (ALC), University of Colorado Anschutz Medical Campus, Denver; Yellow Rose Headache and Neurology-Ophthalmology (DIF), Dallas, TX; Department of Neurology (SP), Thomas Jefferson University, Philadelphia, PA; Bob Bove Neuroscience Institute (JCR), HonorHealth Neurology, Scottsdale, AZ; Department of Neurosurgery (WIS), Cedars Sinai Medical Center, Beverly Hills, CA; Department of Neurology (JKC-G), Mayo Clinic, Rochester, MN; Department of Radiology (TJA), Duke University, Durham, NC; Department of Anesthesia (EH), UCSF, San Francisco, CA; Departments of Neurology (RPC, MJB) and Anesthesiology (JMH, IC), Stanford University, Stanford, CA; Opos Solutions (TJ), San Mateo, CA; and Spinal CSF Leak Foundation (CD, AJB), Spokane, WA
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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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Cheema S, Stubberud A, Rantell K, Nachev P, Tronvik E, Matharu M. Phenotype of new daily persistent headache: subtypes and comparison to transformed chronic daily headache. J Headache Pain 2023; 24:109. [PMID: 37587430 PMCID: PMC10428606 DOI: 10.1186/s10194-023-01639-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/24/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND It is unknown whether new daily persistent headache (NDPH) is a single disorder or heterogenous group of disorders, and whether it is a unique disorder from chronic migraine and chronic tension-type headache. We describe a large group of patients with primary NDPH, compare its phenotype to transformed chronic daily headache (T-CDH), and use cluster analysis to reveal potential sub-phenotypes in the NDPH group. METHODS We performed a case-control study using prospectively collected clinical data in patients with primary NDPH and T-CDH (encompassing chronic migraine and chronic tension-type headache). We used logistic regression with propensity score matching to compare demographics, phenotype, comorbidities, and treatment responses between NDPH and T-CDH. We used K-means cluster analysis with Gower distance to identify sub-clusters in the NDPH group based on a combination of demographics, phenotype, and comorbidities. RESULTS We identified 366 patients with NDPH and 696 with T-CDH who met inclusion criteria. Patients with NDPH were less likely to be female (62.6% vs. 73.3%, p < 0.001). Nausea, vomiting, photophobia, phonophobia, motion sensitivity, vertigo, and cranial autonomic symptoms were all significantly less frequent in NDPH than T-CDH (p value for all < 0.001). Acute treatments appeared less effective in NDPH than T-CDH, and medication overuse was less common (16% vs. 42%, p < 0.001). Response to most classes of oral preventive treatments was poor in both groups. The most effective treatment in NDPH was doselupin in 45.7% patients (95% CI 34.8-56.5%). Cluster analysis identified three subgroups of NDPH. Cluster 1 was older, had a high proportion of male patients, and less severe headaches. Cluster 2 was predominantly female, had severe headaches, and few associated symptoms. Cluster 3 was predominantly female with a high prevalence of migrainous symptoms and headache triggers. CONCLUSIONS Whilst there is overlap in the phenotype of NDPH and T-CDH, the differences in migrainous, cranial autonomic symptoms, and vulnerability to medication overuse suggest that they are not the same disorder. NDPH may be fractionated into three sub-phenotypes, which require further investigation.
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Affiliation(s)
- Sanjay Cheema
- Headache and Facial Pain Group, University College London (UCL) Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
- The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
| | - Anker Stubberud
- Headache and Facial Pain Group, University College London (UCL) Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- High Dimensional Neurology Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
- Department of Neuromedicine and Movement Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- NorHEAD Norwegian Centre for Headache Research, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Khadija Rantell
- Education Unit, University College London (UCL) Queen Square Institute of Neurology, London, UK
| | - Parashkev Nachev
- The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- High Dimensional Neurology Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Erling Tronvik
- Department of Neuromedicine and Movement Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- NorHEAD Norwegian Centre for Headache Research, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Manjit Matharu
- Headache and Facial Pain Group, University College London (UCL) Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- NorHEAD Norwegian Centre for Headache Research, NTNU Norwegian University of Science and Technology, Trondheim, Norway
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Qiu D, Wang W, Mei Y, Tang H, Yuan Z, Zhang P, Zhang Y, Yu X, Yang C, Wang Q, Wang Y. Brain structure and cortical activity changes of new daily persistent headache: multimodal evidence from MEG/sMRI. J Headache Pain 2023; 24:45. [PMID: 37098498 PMCID: PMC10129440 DOI: 10.1186/s10194-023-01581-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 04/18/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND New daily persistent headache (NDPH) is a rare but debilitating primary headache disorder that poses a significant burden on individuals and society. Despite its clinical importance, the underlying pathophysiological mechanisms of NDPH remain unclear. In this study, we aimed to investigate the brain structural changes and neural activity patterns in patients with NDPH using multimodal brain imaging analysis of structural magnetic resonance imaging (sMRI) combined with magnetoencephalography (MEG). METHODS Twenty-eight patients with NDPH and 37 healthy controls (HCs) were recruited for this study, and their structural and resting-state data were collected by 3.0 Tesla MRI and MEG. We analyzed the brain morphology using voxel-based morphometry and source-based morphometry. In each brain region, MEG sensor signals from 1 to 200 Hz were analyzed using an adapted version of Welch's method. MEG source localization was conducted using the dynamic statistical parametric mapping, and the difference of source distribution between patients with NDPH and HCs was examined. RESULTS Our results revealed significant differences in the regional grey matter volume, cortical thickness, and cortical surface area between the two groups. Specifically, compared with HCs, patients with NDPH showed a significant decrease in cortical thickness of the left rostral cortex in the middle frontal gyrus, decreased cortical surface area of the left fusiform gyrus, decreased grey matter volume of the left superior frontal gyrus and the left middle frontal gyrus, and increased grey matter volume of the left calcarine. Furthermore, the power of the whole brain, bilateral frontal lobes, and right temporal lobe in the NDPH group were higher than that in HCs in the ripple frequency band (80-200 Hz). Functional and structural analysis suggested that there were structural changes and abnormal high frequency cortical activity in both frontal and temporal lobes in patients with NDPH. CONCLUSION Our findings indicated that patients with NDPH have abnormalities in brain morphology, such as cortical area, cortical thickness, and grey matter volume, accompanied by abnormal cortical neural activity. Brain structural changes in the frontotemporal cortex and abnormalities in cortical ripple activity may be involved in the pathogenesis of NDPH.
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Affiliation(s)
- Dong Qiu
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, 100070, Beijing, China
| | - Wei Wang
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, 100070, Beijing, China
| | - Yanliang Mei
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, 100070, Beijing, China
| | - Hefei Tang
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, 100070, Beijing, China
| | - Ziyu Yuan
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, 100070, Beijing, China
| | - Peng Zhang
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, 100070, Beijing, China
| | - Yaqing Zhang
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, 100070, Beijing, China
| | - Xueying Yu
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, 100070, Beijing, China
| | - Chunqing Yang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, 100070, Beijing, China
| | - Qun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, 100070, Beijing, China
| | - Yonggang Wang
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, 100070, Beijing, China.
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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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Nagaraj K, Wei DY, Puledda F, Weng H, Waheed S, Vandenbussche N, Ong JJY, Goadsby PJ. Comparison and predictors of chronic migraine vs. new daily persistent headache presenting with a chronic migraine phenotype. Headache 2022; 62:828-838. [PMID: 35861031 PMCID: PMC9545870 DOI: 10.1111/head.14362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/13/2022] [Accepted: 05/27/2022] [Indexed: 11/29/2022]
Abstract
Objective To compare the clinical phenotype of patients with chronic migraine (CM) to patients with new daily persistent headache of the chronic migraine subtype (NDPH‐CM). Methods A study was conducted of CM (n = 257) and NDPH‐CM (n = 76) from a tertiary headache center in the UK, and in the US of patients with daily CM (n = 60) and NDPH‐CM (n = 22). Results From the UK cohort, the age of first headache onset was lower in CM (mean ± SD: 16 ± 12 years) than in NDPH‐CM (mean ± SD: 23 ± 14 years; p < 0.001). There was a greater number of associated migrainous symptoms in CM compared to NDPH‐CM (median and interquartile range: 6, 5–8 vs. 5, 4–7; p < 0.001). A family history of headache was more common in CM compared to NDPH‐CM (82%, 202/248, vs. 53%, 31/59; p < 0.001). In the US cohort there were no differences. Osmophobia (B = −1.08; p = 0.002) and older age at presentation to the clinic (B = −0.06; p = 0.001) were negative predictors of NDPH‐CM. Conclusion NDPH‐CM is relatively less migrainous than CM in the UK cohort. Family history of headache is less common in NDPH‐CM, with negative predictors for NDPH‐CM including osmophobia and older age of presentation to the clinic. More work is required to understand the chronic migraine phenotype of new daily persistent headache.
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Affiliation(s)
- Karthik Nagaraj
- Headache Group, Wolfson CARD, Institute of Psychiatry, Psychology and Neuroscience King's College London London UK
- Department of Neurology Bangalore Medical College and Research Institute Bangalore India
| | - Diana Y. Wei
- Headache Group, Wolfson CARD, Institute of Psychiatry, Psychology and Neuroscience King's College London London UK
- NIHR‐Wellcome Trust King's Clinical Research Facility King's College Hospital London UK
| | - Francesca Puledda
- Headache Group, Wolfson CARD, Institute of Psychiatry, Psychology and Neuroscience King's College London London UK
- NIHR‐Wellcome Trust King's Clinical Research Facility King's College Hospital London UK
| | - Hsing‐Yu Weng
- Department of Neurology Taipei Municipal Wanfang Hospital Taipei Taiwan
- Department of Neurology, School of Medicine, College of Medicine Taipei Medical University Taipei Taiwan
| | - Sadaf Waheed
- Headache Group, Wolfson CARD, Institute of Psychiatry, Psychology and Neuroscience King's College London London UK
| | - Nicolas Vandenbussche
- Headache Group, Wolfson CARD, Institute of Psychiatry, Psychology and Neuroscience King's College London London UK
- Department of Neurology Ghent University Hospital Ghent Belgium
| | - Jonathan J. Y. Ong
- Headache Group, Wolfson CARD, Institute of Psychiatry, Psychology and Neuroscience King's College London London UK
- Division of Neurology, Department of Medicine National University Hospital, National University Health System Singapore Singapore
- Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore
| | - Peter J. Goadsby
- Headache Group, Wolfson CARD, Institute of Psychiatry, Psychology and Neuroscience King's College London London UK
- NIHR‐Wellcome Trust King's Clinical Research Facility King's College Hospital London UK
- Department of Neurology University of California Los Angeles California USA
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Naegel S, Zeller J, Hougard A, Weise CM, Zuelow S, Kleinschnitz C, Obermann M, Solbach K, Holle D. No structural brain alterations in new daily persistent headache - a cross sectional VBM/SBM study. Cephalalgia 2021; 42:335-344. [PMID: 34601946 DOI: 10.1177/03331024211045653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To identify grey matter alterations in patients suffering new daily persistent headache to enrich the pathophysiological concept of this rare headache disorder characterised by a distinct, clearly remembered onset and its instant chronification. METHOD Magnetic resonance-based voxel-based and surface-based morphometry was used to investigate 23 patients suffering from new daily persistent headache and 23 age- and gender-matched healthy controls with 1.5 Tesla MRI.Independent statistical analysis was performed at three sites using statistical parametric mapping, as well as FSL(FMRIB Software Library)-based approaches. RESULTS No grey matter changes were detected using this sophisticated and cross-checked method. CONCLUSION The absence of structural brain changes in patients with new daily persistent headache contribute to the recent discussion regarding structural alterations in primary headache disorders in general and does not provide evidence for grey matter changes being associated with the pathophysiology of new daily persistent headache. Future research will have to determine the underlying pathophysiological mechanisms of this disorder.
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Affiliation(s)
- Steffen Naegel
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany.,Department of Neurology, Westgerman Headache Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Julia Zeller
- Department of Neurology, Westgerman Headache Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany.,Paediatric Haematology and Oncology, Paediatrics III, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Anders Hougard
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty of the University Duisburg-Essen, Essen, Germany
| | - Stefan Zuelow
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University of Duisburg-Essen, University Hospital Essen, Essen, Germany.,Department of Diagnostic and Interventional Radiology and Neuroradiology, Rheinische Friedrich-Wilhelms-Universität, Bonn, Germany
| | - Christoph Kleinschnitz
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Mark Obermann
- Department of Neurology, Westgerman Headache Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany.,Department of Neurology, Klinikum Weser-Egge, Höxter, Germany
| | - Kasja Solbach
- Department of Neurology, Westgerman Headache Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Dagny Holle
- Department of Neurology, Westgerman Headache Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
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8
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Lobo R, Wang M, Lobo S, Bahra A. Time to retire 'New daily persistent headache': Mode of onset of chronic migraine and tension-type headache. Cephalalgia 2021; 42:385-395. [PMID: 34579562 DOI: 10.1177/03331024211044440] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
New daily persistent headache is described as an enigmatic condition with daily headache from onset. It has posed challenges diagnostically and therapeutically.Methods: We conducted a study of patients referred to headache services based in Central and North-East London, United Kingdom, meeting the International Classificaiton of Headache Disorders - 3 criteria for New daily persistent headache. Information on demographics, phenotype and treatment responses were collected. The syndrome of the daily headache was also classified according any other ICHD-3-defined syndrome.Results: Of 162 patients, females comprised 68.5% with median age of onset 35 years. The daily headache experienced was chronic migraine in 89.7% and tension-type headache in 8.8%. Thunderclap-onset New daily persistent headache occurred in 14.8%. More than one headache syndrome was experienced in 15.4%, including cough, hypnic, sexual and stabbing headache. All aura types were experienced, most commonly brainstem aura in 39%. Prior headache was reported 53.7%. A persisting sub-form was present in 51.2%, relapsing remitting in 12.3% and 14.0% reported improvement; 19.8% were lost to follow-up. Only 11.1% reported an antecedent trigger. The most common premorbid disorders were psychiatric in 35.7%. A fifth improved on preventative medication, most commonly amitriptyline, propranolol and topiramate.Conclusion: Our cohort of New daily persistent headache is consistent with a mode of onset of migraine and tension-type headache which occurs in predisposed individuals.
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Affiliation(s)
- Rhannon Lobo
- National Hospital for Neurology and Neurosurgery, 98546National Hospital for Neurology and Neurosurgery, London, UK
| | - Mu Wang
- Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan, 030012, Shanxi Province, China.,Section for Nutrition Research, Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, 4615Imperial College London, Imperial College London, London, UK
| | - Sean Lobo
- Faculty of Life Science and Medicine, King's College London, London, UK
| | - Anish Bahra
- National Hospital for Neurology and Neurosurgery, 98546National Hospital for Neurology and Neurosurgery, London, UK.,Department of Neurology, 9744Barts Health NHS Trust, Whipps Cross Hospital, London, UK
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9
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Uniyal R, Chhirolya R, Tripathi A, Mishra P, Paliwal VK. Is new daily persistent headache a fallout of somatization? An observational study. Neurol Sci 2021; 43:541-547. [PMID: 33991261 DOI: 10.1007/s10072-021-05236-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/07/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVE New daily persistent headache (NDPH) is characterized by daily, persistent headache with clearly remembered onset, preceding events or triggers and treatment refractoriness of headache. The pathophysiology of NDPH is still unresolved. NDPH has been associated with somatoform disorder (DSM 4 TR). Somatization is characterized by vivid memory, disproportionate and persistent thought about symptoms that may explain many characteristics of NDPH. However, tendency towards somatization has not been studied in NDPH patients. METHODS In this cross-sectional study, we evaluated somatization in NDPH, chronic migraine (CM), and chronic tension type headache (CTTH) by comparing the prevalence of somatic symptom disorder (SSD, DSM-5). We evaluated the past tendencies to somatization by comparing various characteristics of past somatic symptoms (number, duration, type, clearly remembered onset, etc.) between NDPH, CM, and CTTH. RESULTS Forty-seven patients each of NDPH and CTTH and 46 patients of CM were evaluated. Criteria for SSD was fulfilled by 85.1% of NDPH and CTTH patients and only 45.7% of CM. Past history of somatic symptoms was seen in 70% patients with NDPH, 15.2% CM, and 23.4% CTTH (p<0.001). Median number of past somatic symptoms was higher in NDPH. All NDPH patients clearly remembered the onset of at least one past somatic symptom. None of CM and CTTH patients remembered the onset of past somatic symptoms. CONCLUSION NDPH patients displayed significant past history of somatization. Continuation of past tendencies to manifest as NDPH suggests that NDPH may be an epiphenomenon of somatization.
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Affiliation(s)
- Ravi Uniyal
- Department of Neurology, King George's Medical University, Lucknow, India
| | - Rohit Chhirolya
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Adarsh Tripathi
- Department of Psychiatry, King George's Medical University, Lucknow, India
| | - Prabhakar Mishra
- Department of Biostatistics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Vimal Kumar Paliwal
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. .,Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, 226014, India.
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Abstract
PURPOSE OF REVIEW This article provides the practicing neurologist with a comprehensive, evidence-based approach to the diagnosis and management of headache in children and adolescents, with a focus on migraine. RECENT FINDINGS Four triptans are now labeled by the US Food and Drug Administration (FDA) for acute migraine treatment in adolescents, and rizatriptan is labeled for use in children age 6 and older. For preventive migraine treatment, the Childhood and Adolescent Migraine Prevention trial demonstrated that approximately 60% of children and adolescents with migraine will improve with a three-pronged treatment approach that includes: (1) lifestyle management counseling (on sleep, exercise, hydration, caffeine, and avoidance of meal skipping); (2) optimally dosed acute therapy, specifically nonsteroidal anti-inflammatory drugs and triptans; and (3) a preventive treatment that has some evidence for efficacy. For the remaining 40% of children and adolescents, and for those who would not have qualified for the Childhood and Adolescent Migraine Prevention trial because of having continuous headache or medication-overuse headache, the clinician's judgment remains the best guide to preventive therapy selection. SUMMARY Randomized placebo-controlled trials have been conducted to guide first-line acute and preventive migraine treatments in children and adolescents. Future research is needed to guide treatment for those with more refractory migraine, as well as for children and adolescents who have other primary headache disorders.
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11
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Rozen TD. New daily persistent headache (NDPH) triggered by a single Valsalva event: A case series. Cephalalgia 2018; 39:785-791. [PMID: 30301379 DOI: 10.1177/0333102418806869] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe a new subtype of new daily persistent headache that is triggered by a single Valsalva event. METHODS A case series of patients was evaluated in an academic headache clinic over a 3-year time period. RESULTS A total of seven patients (four female and three male) were diagnosed with this new subtype of new daily persistent headache. The headaches all began after a single Valsalva event. Average age at time of headache onset was 41 years (males: 39 years; females: 43 years) with an age range of 20-62 years. All patients developed their syndrome during the months of September to February with November and February being the most cited months (5/7 patients). Immediate worsening in the Trendelenburg position occurred in all patients and appeared to be an almost diagnostic test for the syndrome. No patient had papilledema on funduscopic exam. Five out of seven patients had no prior headache history including cough, exercise or migraine. Four of seven patients were of normal weight, while one was overweight and two were obese. A crowded posterior fossa was identified in five of seven patients on brain MRI. On cerebrospinal fluid pressure/volume lowering medication (acetazolamide, indomethacin and/or spironolactone), five out of seven patients achieved 90% plus improvement in headache frequency while three patients became pain free. Three patients were able to taper off medication without headache recurrence. CONCLUSION New daily persistent headache after a single Valsalva event appears to be a unique subtype of new daily persistent headache that is responsive to cerebrospinal fluid pressure/volume lowering medications. An abnormal reset of cerebrospinal fluid pressure/intracranial pressure to an elevated state is the presumed pathogenesis and may relate to the patient's baseline neuroanatomy of a crowded posterior fossa. There appears to be a circadian periodicity to the onset of the syndrome. Worsening in the Trendelenburg position is a probable diagnostic test. Defining new daily persistent headache subtypes by triggering event appears to be making a positive inroad in the understanding of this condition and helps present new effective therapies.
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Affiliation(s)
- Todd D Rozen
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
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12
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Robbins MS, Vanast WJ, Purdy RA. New Daily Persistent Headache: Historical Review and an Interview with Dr. Walter Vanast. Headache 2017; 57:926-934. [DOI: 10.1111/head.13103] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 03/08/2017] [Indexed: 01/03/2023]
Affiliation(s)
- Matthew S. Robbins
- Department of Neurology, Albert Einstein College of Medicine; Montefiore Headache Center; Bronx NY USA
| | - Walter J. Vanast
- Kateri Memorial Hospital Centre; Kahnawake Quebec Canada
- Department of Neurology and Neurosurgery; McGill University; Montreal Quebec Canada
| | - R. Allan Purdy
- Department of Medicine (Neurology); Dalhousie University; Halifax Nova Scotia Canada
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13
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Safonov MI, Naprienko MV. Analysis of the efficacy of reflexology in the complex treatment of chronic migraine. Zh Nevrol Psikhiatr Im S S Korsakova 2017. [DOI: 10.17116/jnevro20171175122-25] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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14
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Gan’shina TS, Gorbunov AA, Gnezdilova AV, Turilova AI, Kostochka LM, Pyatin BM, Avdyunina NI, Grushevskaya LN, Mirzoyan RS. Tropoxin – Drug for the Treatment of Migraine. Pharm Chem J 2016. [DOI: 10.1007/s11094-016-1391-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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15
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Short-term diagnostic stability of probable headache disorders based on the International Classification of Headache Disorders, 3rd edition beta version, in first-visit patients: a multicenter follow-up study. J Headache Pain 2016; 17:13. [PMID: 26892842 PMCID: PMC4759261 DOI: 10.1186/s10194-016-0605-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 02/12/2016] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND A "Probable headache disorder" is diagnosed when a patient's headache fulfills all but one criterion of a headache disorder in the 3rd beta edition of the International Classification of Headache Disorder (ICHD-3β). We investigated diagnostic changes in probable headache disorders in first-visit patients after at least 3 months of follow-up. METHODS This was a longitudinal study using a prospective headache registry from nine headache clinics of referral hospitals. The diagnostic change of probable headache disorders at baseline was assessed at least 3 months after the initial visit using ICHD-3β. RESULTS Of 216 patients with probable headache disorders at baseline, the initial probable diagnosis remained unchanged for 162 (75.0 %) patients, while it progressed to a definite diagnosis within the same headache subtype for 45 (20.8 %) by fulfilling the criteria during a median follow-up period of 6.5 months. Significant difference on the proportions of constant diagnosis was not found between headache subtypes (P < 0.935): 75.9 % for probable migraine, 73.7 % for probable tension-type headache (TTH), and 76.0 % for probable other primary headache disorders (OPHD). Among patients with headache recurrence, the proportion of constant diagnosis was higher for probable migraine than for probable TTH plus probable OPHD (59.2 vs. 23.1 %; P < 0.001). The proportions of constant diagnosis did not significantly differ by follow-up duration (>3 and ≤ 6 months vs. > 6 and ≤ 10 months) in probable migraine, probable TTH, and probable OPHD, respectively. CONCLUSIONS In this study, a probable headache diagnosis, based on ICHD-3β, remained in approximately three-quarters of the outpatients; however, diagnostic stability could differ by headache recurrence and subtype. Probable headache management might have to consider these differences.
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Mitsikostas DD, Ashina M, Craven A, Diener HC, Goadsby PJ, Ferrari MD, Lampl C, Paemeleire K, Pascual J, Siva A, Olesen J, Osipova V, Martelletti P. European Headache Federation consensus on technical investigation for primary headache disorders. J Headache Pain 2016; 17:5. [PMID: 26857820 PMCID: PMC4747925 DOI: 10.1186/s10194-016-0596-y] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 02/02/2016] [Indexed: 01/03/2023] Open
Abstract
The diagnosis of primary headache disorders is clinical and based on the diagnostic criteria of the International Headache Society (ICHD-3-beta). However several brain conditions may mimic primary headache disorders and laboratory investigation may be needed. This necessity occurs when the treating physician doubts for the primary origin of headache. Features that represent a warning for a possible underlying disorder causing the headache are new onset headache, change in previously stable headache pattern, headache that abruptly reaches the peak level, headache that changes with posture, headache awakening the patient, or precipitated by physical activity or Valsalva manoeuvre, first onset of headache ≥50 years of age, neurological symptoms or signs, trauma, fever, seizures, history of malignancy, history of HIV or active infections, and prior history of stroke or intracranial bleeding. All national headache societies and the European Headache Alliance invited to review and comment the consensus before the final draft. The consensus recommends brain MRI for the case of migraine with aura that persists on one side or in brainstem aura. Persistent aura without infarction and migrainous infarction require brain MRI, MRA and MRV. Brain MRI with detailed study of the pituitary area and cavernous sinus, is recommended for all TACs. For primary cough headache, exercise headache, headache associated with sexual activity, thunderclap headache and hypnic headache apart from brain MRI additional tests may be required. Because there is little and no good evidence the committee constructed a consensus based on the opinion of experts, and should be treated as imperfect.
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Affiliation(s)
- D D Mitsikostas
- Neurology Department, Athens Naval Hospital, Athens, Greece.
| | - M Ashina
- Danish Headache Center, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - A Craven
- European Headache Alliance, President, Dublin, Ireland.
| | - H C Diener
- Department of Neurology, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
| | - P J Goadsby
- Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, and King's Clinical Research Facility, Kings College London, Wellcome Foundation Building, King's College Hospital, London, SE5 9PJ, UK.
| | - M D Ferrari
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - C Lampl
- Medical Headache Center, Hospital Sisters of Mercy, Seilerstaette Linz, Linz, 4020, Austria.
| | - K Paemeleire
- Department of Neurology, Ghent University Hospital, Ghent, Belgium.
| | - J Pascual
- University Hospital Marqués de Valdecilla and IDIVAL, 39011, Santander, Spain.
| | - A Siva
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Millet Cad, 34390, Capa/Istanbul, Turkey.
| | - J Olesen
- Danish Headache Centre and Department of Neurology, Rigshospitalet, Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - V Osipova
- Department of Neurology, First Moscow State Medical University, Moscow, Russia.
| | - P Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy.
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Rozen TD. Triggering Events and New Daily Persistent Headache: Age and Gender Differences and Insights on Pathogenesis-A Clinic-Based Study. Headache 2015; 56:164-73. [PMID: 26474179 DOI: 10.1111/head.12707] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2015] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To define what are the age and gender differences for new daily persistent headache (NDPH) triggering events and how this may relate to the pathogenesis of NDPH. To describe several new triggering events for NDPH. METHODS All patients were diagnosed with primary NDPH at a headache specialty clinic during the time period of 01/2009 through 01/2013. This was a retrospective analysis of patient medical records utilizing an electronic medical record system. RESULTS Ninety-seven patients were diagnosed with primary NDPH (65 women and 32 men). The mean average age of onset was younger in women than men 32.4 years vs 35.8 years. Fifty one of ninety seven NDPH patients (53%) did not recognize a triggering event while an infection or flu-like illness triggered NDPH in 22%, a stressful life event in 9%, a procedure (surgical) in 9%, and some "other" recognized trigger in 7%. All of the NDPH patients who developed new onset headache after an invasive surgical procedure were intubated. There was no significant difference in frequency for any of the triggering events between genders. The youngest age of onset was for a post stressful life event trigger while the oldest age of onset was in the post-surgical subgroup. Women developed NDPH at a younger age of onset for all recognized triggers, but there was no significant difference in ages of onset between the genders. There was no significant difference in the number of NDPH patients who had a history of migraine or no history and if they developed NDPH after any triggered event vs no triggering event. However, the majority of patients who developed NDPH after a stressful life event did have a precedent migraine history (67%). Newly noted triggers include: hormonal manipulation with progesterone, medication exposure, chemical/pesticide exposure, massage treatment, and immediately post a syncopal event. CONCLUSION More than 50% of NDPH sufferers do not recognize a triggering event to their headaches. A key finding from the present study is the recognition that of those patients who developed NDPH after an invasive surgical procedure all required intubation and we speculate a cervicogenic origin to their headaches. The fact that both genders had an almost equal rate of occurrence for most NDPH triggers and almost the same age of onset suggests a common underlying pathogenesis for similar triggering events. A precedent history of migraine did not enhance the frequency of triggered vs nontriggered NDPH except possibly for a stressful life event.
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Affiliation(s)
- Todd D Rozen
- Geisinger Health System, Department of Neurology, Geisinger Headache Clinic, Wilkes-Barre, PA, USA
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18
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Joshi SG, Mathew PG, Markley HG. New daily persistent headache and potential new therapeutic agents. Curr Neurol Neurosci Rep 2014; 14:425. [PMID: 24402404 DOI: 10.1007/s11910-013-0425-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
New daily persistent headache is a form of a chronic daily headache with a unique temporal profile. Patients can recall the exact day when their headache started. It can be one of the most refractory types of headache to treat. Recent publications have highlighted different subtypes and heterogeneity in presentation. Referring to it as a syndrome versus a distinct disorder has also been suggested. Several different classes of medications have been used for the treatment, with mixed results. The underlying pathophysiology of new daily persistent headache is unclear, but tumor necrosis factor may play a role. The clinical features, differential diagnosis and potential new therapeutic agents will be discussed.
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Affiliation(s)
- Shivang G Joshi
- Department of Neurology, New England Regional Headache Center, University of Massachusetts Medical School, 85 Prescott Street Suite 101, Worcester, MA, 01605, USA,
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Gelfand AA, Reider AC, Goadsby PJ. Outcomes of greater occipital nerve injections in pediatric patients with chronic primary headache disorders. Pediatr Neurol 2014; 50:135-9. [PMID: 24268688 PMCID: PMC3903978 DOI: 10.1016/j.pediatrneurol.2013.09.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 09/02/2013] [Accepted: 09/09/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Chronic migraine is common in pediatrics and generally disabling. In adults, infiltration of the area around the greater occipital nerve can provide short- to medium-term benefit in some patients. This study reports the efficacy of greater occipital nerve infiltrations in pediatric patients with chronic primary headache disorders. METHODS Retrospective chart review of patients <18 years with a chronic primary headache disorder undergoing a first-time injection. Infiltrations were unilateral and consisted of a mixture of methylprednisolone acetate, adjusted for weight, and lidocaine 2%. RESULTS Forty-six patients were treated. Thirty-five (76%) had chronic migraine, 9 (20%) new daily persistent headache (NDPH), and 2 (4%) a chronic trigeminal autonomic cephalalgia. Medication overuse was present in 26%. Ages ranged from 7 to 17 years. Follow-up data were available for 40 (87%). Overall, 53% (21/40) benefitted, and 52% (11/21) benefitted significantly. Benefit onset ranged from 0 to 14 days, mean 4.7 (SD 4.3), with mean benefit duration of 5.4 (SD 4.9) weeks. In chronic migraine, 62% (18/29) benefitted, and 56% (10/18) significantly benefitted. In NDPH, 33% (3/9) benefitted; 33% (n = 1) significantly. Neither child with a chronic trigeminal autonomic cephalalgia benefitted. In logistic regression modeling, medication overuse, age, sex, and sensory change in the distribution of the infiltrated nerve did not predict outcome. There were no serious side effects. CONCLUSIONS Greater occipital nerve injections benefitted 53% of pediatric patients with chronic primary headache disorders. Efficacy appeared greater in chronic migraine than NDPH. Given the benign side effect profile, a greater occipital nerve infiltration seems appropriate before more aggressive approaches.
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Affiliation(s)
- Amy A Gelfand
- Headache Center, University of California, San Francisco, San Francisco, California; Division of Child Neurology, University of California, San Francisco, San Francisco, California.
| | - Amanda C Reider
- School of Medicine, University of California, San Francisco, San Francisco, California
| | - Peter J Goadsby
- Headache Center, University of California, San Francisco, San Francisco, California
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New daily persistent headache and radiologically isolated syndrome. J Neurol 2013; 260:2179-81. [PMID: 23835633 DOI: 10.1007/s00415-013-7015-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Revised: 05/25/2013] [Accepted: 06/18/2013] [Indexed: 10/26/2022]
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22
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Robbins MS, Evans RW. The Heterogeneity of New Daily Persistent Headache. Headache 2012; 52:1579-89. [DOI: 10.1111/j.1526-4610.2012.02280.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Matthew S. Robbins
- Montefiore Headache Center, Saul R. Korey Department of Neurology; Albert Einstein College of Medicine; Bronx; NY; USA
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Abstract
PURPOSE OF REVIEW Recent evidence supports the suggestion that migraine is a chronic disorder with episodic attacks that increase in frequency in a subgroup of patients, transforming migraine into a refractory chronic condition with poor outcome and severe impact. Among the risk factors for migraine chronification depression figures notably. Early diagnosis and management of risk factors in migraineurs prevent migraine chronification and its consequences. The scope of this article is to review depression as a potential cofactor for migraine chronification. RECENT FINDINGS Population-based studies revealed that migraineurs often have symptoms of depression, with strongest associations for migraine with aura. Patients with depression also have an increased risk for migraine, migraine with aura in particular. Twin studies showed similar findings. This bidirectional relationship suggests that migraine and depression may share common causative factors, possibly genetically determined, that might control migraine chronification. Migraine patients may develop depression as a result of the demoralizing experience of recurrent and disabling headaches and depressed patients may develop migraine because of increased pain sensitivity, in the basis of a common genetic background. SUMMARY We suggest that clinicians consider depression as part of migraine management in order to optimize treatment and avoid migraine progression.
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