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3-Year follow-up of secondary chronic headaches: the Akershus study of chronic headache
Kjersti Aaseth1, Ragnhild Berling Grande, Jūratė Šaltytė Benth
1Head and Neck Research Group, Research Centre, Akershus University Hospital, 1478 Lørenskog, Norway. kjersti.aaseth@medisin.uio.no
Insights
Secondary chronic headaches, including chronic posttraumatic headache and headache attributed to chronic rhinosinusitis, showed improved outcomes over three years. However, cervicogenic headache did not demonstrate significant changes, highlighting subtype-specific disease courses.
Area of Science:
- Neurology
- Epidemiology
- Public Health
Background:
- Secondary chronic headaches, defined as headaches occurring 15 days or more per month for at least three months, represent a significant clinical challenge.
- Understanding the long-term course of these debilitating conditions is crucial for effective patient management and public health strategies.
Purpose of the Study:
- To investigate the 3-year clinical course of various secondary chronic headache subtypes within a general population sample.
- To compare the progression and outcomes of chronic posttraumatic headache, cervicogenic headache (CEH), and headache attributed to chronic rhinosinusitis (HACRS).
Main Methods:
- A 3-year prospective study involving a randomly selected population sample aged 30-44 years.
- Initial screening via mailed questionnaires followed by in-depth interviews using the International Classification of Headache Disorders (ICHD-II), Cervicogenic Headache International Study Group, and American Academy of Otolaryngology criteria.
- Assessment of headache index (frequency x intensity x duration) at baseline and follow-up.
Main Results:
- Of the participants with chronic headache, specific diagnoses included chronic posttraumatic headache (n=40), CEH (n=18 by specific criteria), and HACRS (n=37 by specific criteria).
- A significant reduction in the headache index was observed for chronic posttraumatic headache and HACRS from baseline to follow-up.
- No significant improvement in the headache index was noted for cervicogenic headache (CEH) over the 3-year study period.
Conclusions:
- The clinical course of secondary chronic headaches varies significantly depending on the specific subtype.
- Distinguishing between different types of secondary chronic headaches is essential, as this has direct implications for treatment strategies and patient prognosis.
- Further research into subtype-specific management is warranted to optimize outcomes for individuals suffering from chronic headache conditions.
Abstract:
The objective was to investigate the 3-year course of secondary chronic headaches (⩾15days per month for at least 3months) in the general population. An age and gender stratified random sample of 30,000 persons aged 30-44years from the general population received a mailed questionnaire. All with self-reported chronic headache, 517 in total, were interviewed by neurological residents. The questionnaire response rate was 71%. The rate of participation in the initial and follow-up interview was 74% (633/852) and 87% (83/95) respectively. The International Classification of Headache Disorders was used, and then in the next step the Cervicogenic Headache International Study Group and American Academy of Otolaryngology criteria were used in relation to cervicogenic headache (CEH) and headache attributed to chronic rhinosinusitis (HACRS). Of those followed-up, 40 had headache attributed to head and/or neck trauma (chronic posttraumatic headache), 0 had CEH and 0 had HACRS according to the ICHD-II criteria, while 18 had CEH according to the Cervicogenic Headache International Study Group's criteria, and 37 had HACRS according to the criteria of the American Academy of Otolaryngology. The headache index (frequency×intensity×duration) was significantly reduced from baseline to follow-up in chronic posttraumatic headache and HACRS, but not in CEH. We conclude that secondary chronic headaches seem to have various course dependent of subtype. Recognizing the different types of secondary chronic headaches is of importance because it might have management implications.