[Primary chronic daily headache: a report on 52 cases]

Area of Science:

• Neurology
• Clinical Medicine

Context:

• Chronic daily headache (CDH) affects a significant patient population.
• Diagnosis of CDH includes transformed migraine, chronic tension-type headache, and new daily persistent headache.
• Drug-induced headache is a common comorbidity in CDH patients due to excessive symptomatic medication use.

Purpose:

• To evaluate the efficacy of a treatment regimen for chronic daily headache (CDH).
• To assess the impact of amitriptyline and propranolol combined with symptomatic medication withdrawal on CDH frequency.
• To identify factors associated with treatment success or failure in CDH patients.

Summary:

• A study of 52 patients with chronic daily headache (CDH) identified transformed migraine (75%), chronic tension-type headache (21.1%), and new daily persistent headache (3.9%) as primary types.
• Thirty-four patients had drug-induced headache from excessive symptomatic medication use.
• Treatment with escalating doses of amitriptyline, with or without propranolol, and cessation of symptomatic drugs reduced headache frequency in most CDH patients.
• Beneficial effects persisted for up to six months.
• Treatment failure was statistically associated with the continued overuse of symptomatic medications.

Impact:

• The findings suggest a viable treatment strategy for managing chronic daily headache (CDH), particularly when drug-induced headache is present.
• Identifying the link between symptomatic medication overuse and treatment failure highlights a critical factor for clinical intervention.
• This research provides evidence for the long-term effectiveness of a specific therapeutic approach in reducing headache burden.