Session 8: Chronic daily headache/tension-type headache

In this study, the causes, predisposing factors and clinical features of chronic daily headache in children and adolescents were studied within the population of patients attending a specialist headache. The International Headache Society's (IHS) criteria for the diagnosis of chronic tension type headache (CTTH) were assessed for their applicability in the paediatric age group. Over a period of three years, demographic and clinical data were collected prospectively on all children who attended the clinic and suffered from daily attacks of headache. One hundred and fifteen children and adolescents (32% of all clinic population) had chronic daily headache, of whom 93 patients (81%) fulfilled the IHS criteria for the diagnosis of CTTH. They were between 3-15 years of age (mean: 11.1, SD: 2.3) and their female to male ratio was 1.2: 1. Around one third of the patients also suffered from migraine (mainly migraine without aura). The headache was described as mild in 60.9%, moderate 36.5% and severe 2.6%. Headache was located at the forehead in 53% or over the whole of the head in 29.6%. Pain was described as ‘just sore’ or dull by 73.9%. During attacks of headache, at least half the patients reported light intolerance, noise intolerance, anorexia or nausea. Thirty-two percent of patients had at least one underlying chronic disease that may have contributed to the pathogenesis of the CTTH. Eleven percent had serious stressful events related to family illnesses and in four patients headaches were triggered by family bereavement. Fourteen percent were investigated with neuroimaging and 22% were referred for clinical psychology assessment and management. In conclusion, CTTH is a common cause of headache in children attending a specialist headache clinic. The clinical features closely match those of adult population and the IHS criteria for the diagnosis of CTTH can be adapted for use in children. Predisposing stressful risk factors, physical or emotional, are present in a large proportion.

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An epidemiological approach to the nosography of chronic daily headache

Cephalalgia ◽

10.1177/0333102493013s1216 ◽

1993 ◽

Vol 13 (12_suppl) ◽

pp. 72-77 ◽

Cited By ~ 39

Author(s):

Giorgio Sandrini ◽

Gian Camillo Manzoni ◽

Carla Zanferrari ◽

Giuseppe Nappi

Keyword(s):

Clinical Features ◽

Chronic Daily Headache ◽

Tension Type Headache ◽

Chronic Tension Type Headache ◽

Transformed Migraine ◽

Daily Headache ◽

Ihs Criteria ◽

Recent Classification ◽

Type Headache ◽

Epidemiological Approach

Chronic daily headache (CDH), a heterogeneous group of headaches, includes different forms that occur daily, or almost daily, over a prolonged period of time. The nosography of this group is still a matter of debate, and in the most recent classification of the IHS (1988) only a few types of CDH are included: chronic tension-type headache, coexisting migraine. This study is an epidemiological approach to identifying the clinical features of CDH and the possible factors involved in changing episodic headache in CDH. Ninety CDH outpatients were investigated using a computerized record chart. The main observed forms were: (a) chronic tension-type headache–migraine with interparoxysmal headache, an evolved form of migraine in which a constant low severity headache develops between attacks; (b) transformed migraine, an evolved form of migraine with progressive worsening of the disease which reaches the level of continuous pain with the disappearance of typical migraine attacks. Interval headaches in migraine with interparoxysmal headache partly fulfil the IHS criteria for chronic tension-type headache. Analgesic drug abuse plays a prominent role in inducing CDH and in determining its clinical features.

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Transformed migraine

Cephalalgia ◽

10.1177/0333102493013s1217 ◽

1993 ◽

Vol 13 (12_suppl) ◽

pp. 78-83 ◽

Cited By ~ 107

Author(s):

Ninan T Mathew

Keyword(s):

Chronic Daily Headache ◽

Tension Type Headache ◽

Drug Induced ◽

Chronic Tension Type Headache ◽

Transformed Migraine ◽

Mixed Features ◽

History Of ◽

Daily Headache ◽

International Headache Classification ◽

Type Headache

Chronic tension-type headache, which is included in the International Headache Classification, is present in only a minority of patients who present with chronic daily headache. The majority have what is termed transformed migraine, with a history of distinct episodes of migraine in the initial years which progresses into chronic daily headache. These patients with transformed migraine exhibit mixed features of migraine and chronic tension-type headache. Two distinct types of transformed migraine are identifiable, namely those related to excessive intake of medications (drug-induced transformed migraine) and those unrelated to excessive use of medications. The clinical features of transformed migraine and the drug-induced variety are described. The need for revision of the International Classification to include chronic daily headache and the subtypes of transformed migraine is pointed out.

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Study of Sleep Disorders and Polysomnographic Evaluation among Primary Chronic Daily Headache Patients

Journal of Neurosciences in Rural Practice ◽

10.4103/0976-3147.196469 ◽

2016 ◽

Vol 07 (S 01) ◽

pp. S072-S075 ◽

Cited By ~ 2

Author(s):

Rajesh Verma ◽

Kamal Kumar Nagar ◽

Ravindra Kumar Garg ◽

Ravi Uniyal ◽

Praveen Kumar Sharma ◽

...

Keyword(s):

Sleep Disorders ◽

Sleep Disorder ◽

Chronic Daily Headache ◽

Daytime Sleepiness ◽

Structured Interview ◽

Tension Type Headache ◽

Chronic Tension Type Headache ◽

Daily Headache ◽

Type Headache ◽

Headache Patients

ABSTRACT Objective: Studies related to sleep disorders and polysomnography (PSG) among chronic daily headache patients are rare. We studied this and compared chronic migraine (CM) with chronic tension-type headache. Methods: Eighty-three patients were recruited. They were evaluated by semi-structured interview, headache, and sleep diaries along with Epworth Sleepiness Scale score and insomnia symptom score. Overnight PSG was performed and data compared. Results: Chronic tension-type headache was more common than CM, both having female preponderance. Insomnia followed by excessive daytime sleepiness was prevalent sleep disorder. Sleep efficiency and Stage 3 sleep were lower in CM compared to chronic tension-type. ESSS was significantly increased among chronic tension-type patients. No significant correlation was found among PSG parameters in patients with or without sleep disorders. Conclusion: Insomnia being most common sleep disorder among chronic headache population. Chronic tension-type headache had slightly better slow-wave sleep than CM and significantly increased daytime sleepiness.

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Contingent Negative Variation in Patients with Chronic Daily Headache

Cephalalgia ◽

10.1046/j.1468-2982.1998.1808565.x ◽

1998 ◽

Vol 18 (8) ◽

pp. 565-569 ◽

Cited By ~ 18

Author(s):

M Siniatchkin ◽

W-D Gerber ◽

P Kropp ◽

A Vein

Keyword(s):

Chronic Daily Headache ◽

Contingent Negative Variation ◽

Migraine Without Aura ◽

Tension Type Headache ◽

Transformed Migraine ◽

Early Component ◽

Predictive Variables ◽

Environment Control ◽

Daily Headache ◽

Type Headache

The aim of this study was the investigation of amplitude and habituation of contingent negative variation (CNV) in migraine and chronic daily headache (CDH) patients in order to describe possible neurophysiological features responsible for the clinical transformation and worsening of the headache. Fifteen females suffering from migraine without aura and 15 females diagnosed with CDH evolved from migraine without aura with interparoxysmal chronic tension-type headache (transformed migraine), underwent CNV recording. Fifteen healthy females matched for age served as controls. CNV was obtained from C3 and C4 using the standard reaction time paradigm and 3 sec ISI. The amplitudes and habituation of total CNV, early and late components, and of post-imperative negative variation (PINV) were calculated. The migraine patients were characterized by significantly more pronounced negativity of the early component and total CNV, compared to CDH sufferers and controls. CDH patients demonstrated significantly reduced negativity of the late component and pronounced PINV compared to the other groups. The early component of CNV did not habituate in migraine or CDH patients. However, the impaired habituation in CDH was related to significantly lower amplitudes. These results support the diagnostic and scientific value of habituation in migraine research and therapy. Late components of CNV and PINV can be considered as predictive variables for transformation of migraine. The results are discussed in terms of the relationship between late CNV, PINV, environment control abilities and susceptibility for development of depression.

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Evaluation of Chronic Daily Headache—Comparison to Criteria for Chronic Tension-Type Headache

Cephalalgia ◽

10.1111/j.1468-2982.1992.00365.x ◽

1992 ◽

Vol 12 (6) ◽

pp. 365-368 ◽

Cited By ~ 59

Author(s):

Seymour Solomon ◽

Richard B Lipton ◽

Lawrence C Newman

Keyword(s):

Chronic Daily Headache ◽

Medication Overuse ◽

International Headache Society ◽

Tension Type Headache ◽

Chronic Tension Type Headache ◽

Ihs Classification ◽

Analgesic Medication ◽

Daily Headache ◽

Ihs Criteria ◽

Type Headache

The purpose of this study was to evaluate the adequacy of the International Headache Society (IHS) criteria for chronic tension-type headache and, if appropriate, suggest modifications of the IHS classification. We evaluated 100 consecutive patients with chronic daily headache. Approximately two-thirds of our patients fulfilled the criteria for chronic tension-type headache. Most of the patients who failed to meet the criteria did so because they had more than one migrainous feature. Approximately 50% of patients took excessive amounts of analgesic medication. We conclude that the IHS criteria should be modified to include chronic daily headache evolving from migraine; subtypes with and without medication overuse should be distinguished.

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Integrative East–West Medicine Intervention for Chronic Daily Headache: A Case Report and Care Perspective

Global Advances in Health and Medicine ◽

10.1177/2164956120905817 ◽

2020 ◽

Vol 9 ◽

pp. 216495612090581

Author(s):

Justin G Laube ◽

Thais Salles Araujo ◽

Lawrence B Taw

Keyword(s):

Chronic Migraine ◽

Chronic Daily Headache ◽

Medication Overuse ◽

Trigger Point ◽

Tension Type Headache ◽

Contributing Factors ◽

Chronic Tension Type Headache ◽

Daily Headache ◽

Type Headache ◽

East West

Chronic daily headache is a group of headache syndromes including most commonly chronic migraine and chronic tension-type headache, which often overlap, are complicated by medication overuse and are disabling, costly, and variable responsive to western pharmacotherapeutic interventions. There is growing research and awareness of integrative health approaches and therapies to address patients with chronic headache, yet limited examples of how to deliver this approach. This article reviews a commonly seen challenging case of a patient with overlapping chronic migraine and chronic tension-type headache complicated by medication overuse managed with an integrative east–west medicine intervention. This included person-centered biopsychosocial history taking, traditional Chinese medicine informed acupuncture, trigger point injections, and contributing factors modifications. A narrative review of the literature is presented to demonstrate an evidence-informed rationale for incorporating nonpharmacologic approaches to effectively help reduce the symptom burden of this patient population.

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Classification of Chronic Daily Headache by International Headache Society Criteria: Limits and New Proposals

Cephalalgia ◽

10.1046/j.1468-2982.1995.1501037.x ◽

1995 ◽

Vol 15 (1) ◽

pp. 37-43 ◽

Cited By ~ 75

Author(s):

GC Manzoni ◽

F Granella ◽

G Sandrini ◽

A Cavallini ◽

C Zanferrari ◽

...

Keyword(s):

Retrospective Study ◽

Chronic Daily Headache ◽

International Headache Society ◽

Tension Type Headache ◽

Clear Cut ◽

Ihs Classification ◽

Daily Headache ◽

Type Headache ◽

Headache Centres

We conducted a retrospective study of 150 patients with chronic daily headache (CDH) to determine how to categorize their headache according to the classification of the International Headache Society (IHS). All patients were first evaluated at Parma and Pavia Headache Centres (from January 1992 to March 1993) and had had headache for at least 15 days a month during the previous 6 months. Four patients were thereafter excluded due to poor reliability. The 146 patients who met our CDH criteria (92 with and 54 without clear-cut migraine attacks) could be classified into four groups: (i) chronic tension-type headache (CTTH)-27 patients; (ii) coexisting migraine plus CTTH-65 patients; (iii) unclassifiable daily headache-27 patients; and (iv) migraine and an unclassifiable interval headache-27 patients. Seventy-two percent of patients with CDH had migraine as the initial form of their headache. We therefore propose to revise the IHS classification for migraine, taking into account its evolution, and add two subcategories, migraine with interparoxysmal headache and chronic migraine.

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Chronic Daily Headache in Children and Adolescents

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100003383 ◽

2004 ◽

Vol 31 (3) ◽

pp. 319-323 ◽

Cited By ~ 25

Author(s):

Shashi S. Seshia

Keyword(s):

Children And Adolescents ◽

Chronic Daily Headache ◽

Specific Treatment ◽

Headache Disorder ◽

Tension Type Headache ◽

Transformed Migraine ◽

Teenage Girls ◽

Daily Headache ◽

Type Headache ◽

Evidenced Based

Objective:Characterize chronic daily headache in those less than 20 years of age. Material andMethods:Study design: Prospective, observational, and sequential.Setting:Private practice Pediatric Neurology Clinic in a Canadian city (Winnipeg).Patients and data collection:Data on those referred with headache between September 1998 and December 2001 were entered on data sheets. Patients were followed up for one month to four years.Results:One hundred and forty-three (31%) of 463 referred with headache had chronic daily headache with duration of one month to five years (median: eight months). The age range was 5.5 years to 20 years (median: 13 years). There were significantly more females (N=93) than males (N=50). The main groups were: (1) transformed migraine: 6 (4%), (2) transformed tension-type headache: 80 (56%) and (3) transformed comorbid migraine and tension-type headache: 39 (27%). Tension-type features dominated in 94%. Analgesia overuse occurred in two. Stressors were recognized in 60 (42%); anxiety disorder was diagnosed in 8 (6%), and depression in 13 (9%). Computed tomography scans were done in 31 (22%), and MRI/MR angiography in 8 (6%) and were normal or showed nonspecific incidental findings. Twenty-two (15%) were lost to follow-up; 115 of the remaining 121 (95%) were headache free or greatly improved, 63 (55%) without specific treatment.Conclusion:Chronic daily headache is a common headache disorder in children and adolescents, especially in teenage girls. A prospective neuropsychiatric approach is necessary for evidenced-based management, since the condition has mental health, social and economic ramifications.

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