Nasally triggered headache.

Chronic headaches are a significant health problem for patients and often a clinical enigma for the medical professionals who treat such patients. The purpose of this case report is to describe the physical therapy diagnosis and management of a patient with chronic daily headache. The patient was a 48-year-old woman with a medical diagnosis of combined common migraine headache and chronic tension-type headache. An exacerbation of these long-standing headache complaints had resulted in a chronic daily headache for the preceding eight months. Symptoms included bilateral headache, neck pain, left facial pain, and tinnitus. Outcome measures used included the Henry Ford Hospital Headache Disability Inventory (HDI) and the Neck Disability Index (NDI). Examination revealed myofascial, articular, postural, and neuromuscular impairments of the head and neck region. Treatment incorporated myofascial trigger point dry needling, orthopaedic manual physical therapy, exercise therapy, and patient education. On the final visit, the patient reported no headaches during the preceding month. There was a 31% improvement in the HDI emotional score, a 42% improvement in the functional score, and a 36% improvement in the total score for the HDI, the latter exceeding the minimal detectable change for the total score on this measure. The NDI at discharge showed an 18% improvement with a maximal improvement during the course of treatment of 26%. Both improvements exceeded the minimal clinically important difference for the NDI. This case report indicates that physical therapy diagnosis and management as described may be indicated for the conservative care of patients with chronic headaches.

To assess whether family history for chronic headache (CH) and drug overuse could represent a risk factor for headache chronification. Among factors investigated as risk factors for chronification of headache disorders, familial liability for CH and drug overuse has been rarely investigated. A total of 105 consecutive patients with daily or nearly daily headache, and 102 consecutive patients with episodic headache matched by age, sex, and type of headache at onset, underwent a structured direct interview about family history for episodic headache, CH with and without medication overuse, substance abuse/dependence, and psychiatric disorders. In total, 80 out of 105 patients with CH received a diagnosis of medication overuse headache (MOH), 21 patients were classified as chronic migraine (CM), and 4 as chronic tension-type headache (CTTH) without drug overuse. Some 38.1% of CH patients reported family history for CH vs only 13.7% of episodic headaches (P = .001). Familiality for CH with medication overuse was reported by 25.7% of cases vs 9.8% of controls (P = .0028). A familial history of substance abuse was reported by 20% of patients vs 5.9% of controls (P = .0026). In all, 28.7% of MOH patients reported family history for CH with medication overuse (P = .0014) and 21.2% for substance abuse (P = .002). Relatives of patients with MOH were more likely than control relatives to suffer from CH (OR = 4.19 [95% CI 2.05-8.53]), drug overuse (OR = 3.7 [95% CI 1.66-8.24]), and substance abuse (OR = 4.3 [95% CI 1.65-11.19]). No differences regarding family history for episodic headache and for psychiatric disorders were found. No differences in family history for CH with drugs overuse and for substance abuse were found between CH patients without overuse and controls. Fifteen CH patients reported family history for alcohol abuse (P = .0003). The significantly increased familial risk for CH, drug overuse, and substance abuse suggests that a genetic factor is involved in the process of headache chronification.

Background: Chronic cluster headache is a severely disabling neurological disorder. Evidence from open-label case series suggest that occipital nerve stimulation may be effective for the treatment of chronic cluster headache. Objective: To evaluate the effectiveness of a microstimulator for chronic cluster headache. Study Design: Prospective, observational feasibility study plus medical record review. Settings: Academic medical center. Methods: Four patients with medically refractory chronic cluster headache underwent implantation of a unilateral bion microstimulator. In-person follow-up was conducted for 12 months after implantation, and a prospective follow-up chart review was carried out to assess long term outcome. Results: Three of the participants returned their headache diaries for evaluation. The mean duration of chronic cluster headache was 14.3 years (range 3 to 29 years). Pain was predominantly or exclusively retroocular/periocular. One participant demonstrated a positive response (> 50% reduction in cluster headache frequency) at 3 months postimplant, while there were 2 responders at 6 months. At least one of the participants continued to show > 60% reduction in headache frequency at 12 months. A chart review showed that at 58-67 months post-implant, all 3 participants reported continued use and benefit from stimulation. No side-shift in attacks was noted in any participant. Adverse events were limited to 2 participants with neck pain and/or cramping with stimulation at high amplitudes; one required revision for a faulty battery. Limitations: Small patient population without control group. Not blinded or randomized. Conclusion: Unilateral occipital nerve stimulation, using a minimally invasive microstimulator, may be effective for the treatment of medically refractory chronic cluster headache. This benefit may occur immediately after implantation, remain sustained up to 5 years after implantation, and occur despite the anterior location of the pain. Prospective, randomized controlled trials of occipital nerve stimulation in chronic cluster headache should proceed. Key words: chronic headache, bion, peripheral nerve stimulation, cluster headache, migraine, occipital

Chronic headaches related to post-dural puncture headaches: a scoping review

BACKGROUND Chronic daily headache is a common problem reported in tertiary centres and headache is more commonly comorbid with psychiatric disorders. Headache associated with psychopathology has exaggerated effects on quality of life and disability. Comorbid psychiatric illnesses are risk factors for headaches becoming chronic. Earlier studies on the comorbidity of headache and psychiatric disorders found that comorbidity was found among 90 % of the samples with chronic headaches. The objectives of the study were to evaluate psychiatric comorbidity of patients with chronic headache and the association between socio-demographic factors and psychiatric disorders in patients with chronic headache. METHODS The present study was done in tertiary care hospital, on psychosocial profile and psychiatric disorders in patients with chronic headaches. The subjects belonging to both sexes and above twenty years were included in the study. After obtaining the socio-demographic details of each subject as per pre-decided intake proforma, each subject was administered with M.I.N.I. Plus. The data obtained were analyzed by statistical methods and the results were compiled. RESULTS According to the study, young age group, females, married, illiterates, and people with low socioeconomic status were suffering from chronic headaches. The most common psychiatric comorbidity seen among the study population was major depressive disorder (MDD), dysthymia, panic disorder with agoraphobia and generalized anxiety disorder (GAD). CONCLUSIONS There is a need to assess psychiatric comorbidity among patients suffering from headaches as early diagnosis will help in the good prognosis of the individuals and better patient care. KEY WORDS Chronic Headache, Psychiatric Comorbidity, Major Depressive Disorder, Panic Disorder, Generalized Anxiety Disorder.

3-Year follow-up of secondary chronic headaches: The Akershus study of chronic headache

The burden of vastly different diseases has been used to predict National Institutes of Health (NIH) research funding, typically including only 1 year of data. A multi-year analysis of related diseases would provide a more accurate assessment of which diseases are funded appropriately compared to their burden, enabling targeted lobbying efforts and policy changes to ensure equitable funding. Determining under- or over-funded psychiatric and neurological diseases over a 13-year period. This ecological study utilized disability-adjusted life years (DALYs) to quantify disease burden. Quantile regression residuals and 95% CIs at several quantiles determined under- or over-funding. Joinpoint regression delineated DALY trends using average annual percent change (AAPC). The United States. Persons contributing DALYs from attention-deficit/hyperactivity disorder, autism, depressive disorders, eating disorders, schizophrenia, epilepsy, headache disorders, multiple sclerosis, Parkinson's disease, or stroke. None. The difference between actual and predicted funding. Changes in DALYs had a greater impact at higher funding levels. Eating and headache disorders were significantly underfunded at all quantiles. The severity of underfunding at the 50 th quantile decreased for eating (363% [CI: 329%, 386%] to 190% [CI: 170%, 204%]) and headache (1497% [CI: 1164%, 1665%] to 676% [CI: 514%, 759%]) disorders from 2011 to 2023. Disability-adjusted life years for eating disorders decreased (AAPC=-1.0% [CI:-1.1%,-0.9%]), whereas DALYs for headache disorders increased marginally (AAPC=0.1% [CI: 0.1%, 0.1%]). Changes in disease burden were correlated with more significant funding changes in diseases with greater baseline funding. The 2 lowest-funded diseases, eating and headache disorders, are being drastically underfunded compared to their disease burden. While this was not correlated with significant aberrations in disease burden trends in the study period, further lobbying efforts and policy changes must be considered to ensure these diseases receive equitable funding.

48.: The effect of brief biofeedback intervention on headache disability and analgesic use in episodic or chronic migraine and chronic tension type headache

The aim of this study was to determine the effectiveness of Mindfulness-Based Stress reduction (MBSR) on perceived pain intensity and quality of life in patients with chronic headache. Thus, forty patients based on the diagnosis of a neurologist and diagnostic criteria of the International Headache Society (IHS) for migraine and chronic tension-type headache were selected and randomly assigned to the intervention group and control group, respectively. The participants completed the Pain and quality of life (SF-36) questionnaire. The intervention group enrolled in an eight-week MBSR program that incorporated meditation and daily home practice, per week, session of 90-minutes. Results of covariance analysis with the elimination of the pre-test showed significantly improvement of pain and quality of life in the intervention group compared with the control group. The findings from this study revealed that MBSR can be used non-pharmacological intervention for improvement the quality of life and development of strategies to cope with pain in patients with chronic headache. And can be used in combination with other therapies such as pharmacotherapy.

This retrospective chart review examined a mediation model of parent and family functioning, childhood depression, and functional disability in youth with chronic headaches. Specifically, we evaluated whether depression mediates the relations between protective parenting and functional disability and between family functioning and functional disability. Children and adolescents with chronic and recurrent headache report elevated symptoms of depression. Children with chronic pain conditions, including chronic headaches, have also been found to originate from families with greater conflict, poorer cohesion, and lower organizational structure, and impaired family functioning is associated with greater disability in youth with chronic pain. Three hundred and eighty-two patients ages 5-17 years who underwent a multidisciplinary evaluation at a tertiary pediatric headache clinic were included in this study. Participants completed a pain intensity rating, the Children's Depression Inventory, and the Functional Disability Inventory. A parent completed the Family Relationship Index and the Adult Responses to Children's Symptoms questionnaires. Structural equation modeling was used to examine a mediation model and several alternative models. Mediation was not supported, but an alternative model with both direct and indirect pathways provided excellent fit to the data: χ2(1) = 0.745, P = .39; comparative fit index = 1.00, root mean square error of approximation = 0.00 (CI: 0.00-0.17). Family functioning (β = -0.19, P < .01) and protective parenting (β = 0.17, P < .01) were associated with depression, but not disability. Depression was linked to disability (β = 0.24, P < .01). There was an indirect pathway from family functioning to depression to disability (β = -0.05, P < .05). Family context is an important variable to consider in youth with chronic headaches and disability. While many studies have identified family functioning and depressive symptoms as separately linked to functional impairment, to our knowledge, we are the first to demonstrate depression as an intermediary variable between family dysfunction and disability within the pediatric headache population.

Chronic headache affects a significant proportion of the population and can be caused by an underlying lesion or a serious condition. This case report describes a 38-year-old male with a history of chronic migraine headaches who presented with syncope. The patient was found to have bilateral papilledema on fundoscopic examination and a well-circumscribed, oval-shaped lesion located within the intraventricular septum on MRI. The lesion was identified as a colloid cyst and was surgically removed through endoscopic transnasal excision. The patient’s symptoms improved significantly postoperatively, including the resolution of his chronic headaches and syncope. This case report highlights the importance of considering space-occupying lesions as a possible cause of chronic headaches, particularly when symptoms do not respond to conventional treatments. It demonstrates that an endoscopic transnasal resection is a feasible approach, even for large colloid cysts.

Background: Headache is one of the most common maladies which affect humans. However, headache has no been sufficiently studied as a cause of morbidity in the developing world. The present study was conducted to study the etiological and clinical profile of chronic headache patients using the second edition of International Classification of Headache Disorders (ICHD-2), in a tertiary care referral centre.Methods: The study included 100 patients with complaints of headache for more than 3 months attending the outpatient department of Government Royapettah hospital, Chennai, Tamil Nadu, India. Patients underwent thorough clinical examination and psychiatric evaluation and clinical investigations were done as and when required.Results: Among the 100 patients with chronic headache, chronic primary headache (82%) was the most common type, with migraine found in 49% of cases, and tension-type headache (TTH) in 23%. Among the secondary types, the most common was headache caused by overuse of analgesics and post sinusitis. Chronic headaches were significantly more common in women and younger age groups.Conclusions: Since more than 90% of headaches seen in practice are primary headaches, it is to be realised that matters have come a long way in the last decade and these is now enough evidence to prove that primary headaches are a genuine potentially treatable biological problem. This study would help in identifying the significant gaps in headache care and in strengthening existing health systems so that they better recognize headache disorders.

Four percent to 5% of the general population suffers from chronic daily or near daily headache. A majority of them are chronic migraine (transformed migraine), and the rest are chronic tension-type headaches. Prophylactic treatments of migraine and chronic tension-type headache are far from satisfactory because of lack of good efficacy, intolerable side effects, development of tachyphylaxis over long-term use, and drug interactions. Comorbidities and analgesic overuse complicate matters further. There has been an increasing search for more effective treatment for chronic headache, which would result in "modification of the disease." Botulinum toxin type A is an emerging treatment for such patients whose headaches are poorly controlled with currently available prophylactic pharmacotherapy or in patients who do not tolerate them and are unable to continue them. Contraindications to acute migraine therapy such as triptans may also be an indication for alternative treatments like botulinum toxin type A. A number of double blind and open-label trials have been done for migraine and chronic tension-type headache. Although some of the well designed double blind, placebo-controlled, randomized clinical trials are in progress, it has been the clinical experience of many physicians that botulinum toxin type A cuts down the frequency and severity of headaches, improves disability scales, improves quality of life, and reduces the need for acute medications. Repeated use of botulinum toxin type A is needed to sustain long-term improvement, and long-term results indicate lack of tachyphylaxis in the majority of patients. Botulinum toxin type A is well tolerated and totally free of many long-term side effects, which are seen with other prophylactic agents. The clinician may be well advised to consider botulinum toxin type A in the most refractory forms of chronic headaches including chronic migraine and chronic tension-type headache. Appropriate injection techniques, selection of injection sites, and appropriate doses are necessary for success.

Sphenopalatine ganglion pulsed radiofrequency treatment in patients suffering from chronic face and head pain

Introduction: Headache is a frequent complaint among children and adolescents. Its prevalence is still poorly described in this Portuguese population. The most frequent primary headache disorders are migraine and tension-type headache. The authors aimed to characterise and to determine the prevalence in a three months period of headache among adolescents in a Portuguese urban county. Methods: Population-based cross-sectional study with data collected through anonymous questionnaire to an adolescent sample attending the third cycle of basic education. The questionnaire was compiled using the International Headache Society diagnostic criteria. Results: A total of 2123 valid questionnaires were obtained. The three months headache prevalence was 74.5%, higher among female adolescents (boys 63.9%, girls 84.6%). Recurrent headache (more than one episode in three months) prevalence was 49.7% and frequent recurrent headache (14 or more episodes in three months) prevalence was 6.2%. Using a visual analog scale from 0-10 points, the average intensity was 4.64 points (boys 4.47, girls 4.77) and 12.4% (boys 9.3%, girls 15.3%) of all adolescents reported severe intensity pain (≥ 7 points). According to the International Headache Society diagnostic criteria 5.4% (boys 4.3%, girls 6.4%) students reported headache that fulfilled migraine criteria and 7.6% (boys 8.3%, girls 7.0%) tension-type headache criteria. Among female adolescents, significant association was detected (p < 0.05) between the increasing age and the prevalence of three months headache as well as headache that fulfilled migraine criteria. Discussion: This study shows the high prevalence of headache among the studied adolescents supporting the need for greater awareness of this clinical entity.