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Published on: June 2, 2014
Frequency and clinical characteristics of chronic daily headache in an outpatient clinic setting
Aleksandra Karbowniczek1, Izabela Domitrz
1Katedra i Klinika Neurologii, Warszawski Uniwersytet Medyczny, ul. Banacha 1 A, 02-097. Warszawa.
Insights
Chronic migraine is the most common cause of chronic daily headache (CDH). Antidepressants are effective for CDH, suggesting a role for serotonin in chronic pain.
Area of Science:
- Neurology
- Headache Medicine
Background:
- Chronic daily headache (CDH) encompasses diverse primary and secondary headache disorders.
- CDH is defined by the International Classification of Headache Disorders, 2nd edition (ICHD-II) as occurring >15 days/month for ≥3 months.
Purpose of the Study:
- To investigate the causes and effective treatments for chronic daily headache (CDH).
Main Methods:
- 1154 headache patients were evaluated in a specialized outpatient clinic.
- Diagnosis involved clinical history, physical/neurological exams, and laboratory tests.
Main Results:
- 185 patients (16%) were diagnosed with CDH (mean age 41, 80% women).
- Chronic migraine (49%) was the leading cause, followed by chronic tension-type headache (18%) and secondary headaches (25%).
- Medication overuse headache affected 15%; tricyclic antidepressants and SSRIs were most effective therapies.
Conclusions:
- Chronic migraine is the primary cause of CDH in this cohort, with higher prevalence in women.
- Antidepressants, particularly TCAs and SSRIs, showed efficacy for all CDH types.
- Serotonergic mechanisms may play a significant role in the pathophysiology of chronic pain syndromes.
Background And Purpose:
Chronic daily headache (CDH) is not a diagnosis but a category that includes many disorders representing primary and secondary headaches. According to the International Classification of Headache Disorders, 2nd edition (ICHD-II), CDH is defined as headache which occurs more often than 15 days per month for at least 3 months.
Material And Methods:
We assessed 1154 headache sufferers diagnosed in our headache outpatient clinic. Clinical history, physical and neurological examination, and laboratory tests were performed to make a diagnosis.
Results:
CDH was diagnosed according to ICHD-II in 185 (16%) patients; their mean age was 41±17 years (80% were women). Chronic migraine was a cause of CDH in 49% (91/185) of patients, chronic tension-type headache in 18% (33/185), secondary headache in 25% (46/185) and unclassified pain in 8%. Medication overuse headache occurred in 15%. The most effective therapy in our patients was treatment with tricyclic antidepressants and selective serotonin reuptake inhibitors.
Conclusions:
The most frequent cause of CDH in our cohort was chronic migraine. Women suffered more frequently than men. Antidepressants were the most effective preventive medications for all types of CDH, which may suggest that serotoninergic mechanisms can be an important factor in the pathophysiology of chronic pain syndromes.
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