New Daily Persistent Headache in a Pediatric Population

2021 ◽  
pp. 088307382110045
Author(s):  
Eric Strong ◽  
Emily Linda Pierce ◽  
Raquel Langdon ◽  
Jeffery Strelzik ◽  
William McClintock ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Medication Overuse ◽  
Pediatric Population ◽  
Medication Overuse Headache ◽  
Activity Level ◽  
New Daily Persistent Headache ◽  
Tertiary Referral Center ◽  
Preventive Medication ◽  
Headache Clinic ◽  
Persistent Headache

Introduction: New daily persistent headache (NDPH) is a primary headache disorder characterized by an intractable, daily, and unremitting headache lasting for at least 3 months. Currently, there are limited studies in the pediatric population describing the characteristics of NDPH. Objective: The objective of the current study is to describe the characteristics of NDPH in pediatric patients presenting to a headache program at a tertiary referral center. Methods: The participants in the current study were pediatric patients who attended the Headache Clinic at Children’s National Hospital between 2016 and 2018. All patients seen in the Headache Clinic were enrolled in an institutional review board–approved patient registry. Results: Between 2016 and 2018, NDPH was diagnosed in 245 patients, representing 14% of the total headache population. NDPH patients were predominantly female (78%) and white (72%). The median age was 14.8 years. The median pain intensity was 6 of 10 (standard deviation = 1.52). Most patients reported experiencing migrainous features, namely, photophobia (85%), phonophobia (85%), and a reduced activity level (88%). Overall, 33% of patients had failed at least 1 preventive medication, and 56% had failed at least 1 abortive medication. Furthermore, 36% of patients were additionally diagnosed with medication overuse headache. Conclusion: NDPH is a relatively frequent disorder among pediatric chronic headache patients. The vast majority of these patients experience migrainous headache characteristics and associated symptoms and are highly refractory to treatment—as evidenced by a strong predisposition to medication overuse headache and high rates of failed preventive management.

Frequency of diagnoses in a specialized headache clinic in Buenos Aires

2019 ◽  
pp. 66-69
Author(s):  
Vanessa Nagel ◽  
Sol Cavanagh ◽  
Marina Olivier ◽  
Natalia Larripa ◽  
Maria T Gutierrez ◽  
...  
Keyword(s):  
Electronic Medical Records ◽  
Medical Records ◽  
Buenos Aires ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Tension Type Headache ◽  
Primary Headaches ◽  
Craniofacial Pain ◽  
Headache Clinic ◽  
Type Headache

Objective: Headache is one of the most frequent reason for consultations in neurology. The global prevalence among adults with migraine is approximately 10% with migraine, 40% for tension-type headache (TTH) and 3% for chronic daily headache. The purpose of this study is to analyze the prevalence of the diagnoses of headache and craniofacial pain among patients evaluated in a specialized headache clinic of Buenos Aires during 2017. Methods: Retrospective, descriptive study. We reviewed the electronic medical records of patients who consulted for headaches or craniofacial pain from January 1st to December 31st, 2017. Diagnoses were made according to the criteria of the International Classification of Headache Disorders (ICHD-3). Results: We reviewed 3254 electronic medical records and documented 3941 diagnoses: headache (93.03%), craniofacial pain (3.62%) and unclassifiable (3.35%). The average age was 43.14 years. 80.7% were women. Primary headaches were the most frequent diagnoses (78.54%). Migraine represented the main diagnosis (87.42%). Episodic migraine without aura was the most prevalent diagnosis (48%). Tension- type headache (TTH) was found in 8.74% of cases of primary headaches and Trigeminal autonomic cephalalgias (TACs) in 2.89%. Medication-overuse headache (MOH) represented 77.93% of the secondary headaches, and most of them also met chronic migraine criteria fulfilled criteria of chronic migraine. Primary trigeminal neuralgia represented 50% of craniofacial pain and 27% were secondary trigeminal neuralgia, mostly postherpetic or posterior to dental procedures. Regardin to the frecuency, 33.58% of the patients had chronic headache. Conclusion: In our section, migraine is the most frequent diagnosis followed by medication-overuse headache. The percentage of chronic headache is higher than the prevalence in the general population, probably because it is a tertiary center.

Clinic-based characterization of continuous headache in children and adolescents: Comparing youth with chronic migraine to those with new daily persistent headache

Cephalalgia ◽  
2020 ◽  
Vol 40 (10) ◽  
pp. 1063-1069 ◽  
Author(s):  
Brooke L Reidy ◽  
Emily J Riddle ◽  
Scott W Powers ◽  
Shalonda K Slater ◽  
Joanne Kacperski ◽  
...  
Keyword(s):  
Chronic Migraine ◽  
Functional Disability ◽  
Medication Overuse ◽  
Clinical Information ◽  
Large Data ◽  
Data Repository ◽  
New Daily Persistent Headache ◽  
Headache Patient ◽  
Headache Onset ◽  
Persistent Headache

Objective To describe the headache characteristics and functional disability of a large sample of treatment-seeking youth with continuous headache and compare these factors across diagnostic subgroups of chronic migraine and new daily persistent headache. Methods This retrospective study utilized clinical information (e.g. diagnosis, headache features, medication overuse, functional disability) from a large data repository of patients initially presenting to a multidisciplinary headache center with continuous headache. Patient inclusion in subgroup analyses for chronic migraine and new daily persistent headache was based on clinician diagnosis using International Classification of Headache Disorders (ICHD) criteria. Results The current sample included 1170 youth (mean age = 13.95 years, 78.8% female) with continuous headache. The overwhelming majority of these youth had headaches with migrainous features, regardless of their clinical diagnosis. Youth with chronic migraine reported a longer history of continuous headache symptoms and earlier age of headache onset than youth with new daily persistent headache and were more likely to have medication overuse. Most youth with continuous headache experienced severe migraine-related functional disability, regardless of diagnostic subgroup. Conclusions Overall, youth with continuous chronic migraine and new daily persistent headache did not have clinically meaningful differences in headache features and associated disability. Findings suggest that chronic migraine and new daily persistent headache may be variants of the same underlying disease.

Treatment of medication-overuse headache: A systematic review

Cephalalgia ◽  
2015 ◽  
Vol 36 (4) ◽  
pp. 371-386 ◽  
Author(s):  
Chia-Chun Chiang ◽  
Todd J Schwedt ◽  
Shuu-Jiun Wang ◽  
David W Dodick
Keyword(s):  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Treatment Strategies ◽  
Preventive Treatment ◽  
Early Discontinuation ◽  
Level Of Evidence ◽  
Preventive Medication ◽  
Long Term Prognosis ◽  
Acute Headache

Introduction The objective of this review is to provide an evidence-based discussion of different treatment strategies for medication-overuse headache (MOH). Method We searched PubMed for articles discussing the treatment and prognosis of MOH published between 2004 and August 2014. Titles, abstract and articles were reviewed systematically. The level of evidence provided by each study of the included articles was determined according to the American Academy of Neurology Clinical practice guideline manual. We discuss the level of evidence to support the early discontinuation/withdrawal of overused medications, the level of evidence to support the use of preventive treatment, the short- and long-term prognosis, and the outcome according to the class of drug overused in patients diagnosed with MOH. Results The initial search resulted in 1313 articles; 68 articles met our inclusion criteria and were discussed. The level of evidence to support early discontinuation of overused medications alone is low due to the absence of controlled studies. Adding preventive medication to early discontinuation led to a better outcome than early discontinuation alone. For patients with chronic migraine (CM) and medication overuse (MO), there are large randomized control trials supporting the use of onabotulinumtoxinA and topiramate without early discontinuation of overuse; however, the evidence is limited since data were obtained from post hoc analysis. Conclusion Considering current available evidence and the systemic toxicity of overusing acute headache medication, we suggest discontinuation of the overused medication with the addition of preventive medication. Appropriately sized, randomized controlled trials evaluating the safety and long-term efficacy of preventive medication plus early discontinuation of overuse vs preventive medication alone vs early discontinuation of overuse alone are needed.

scholarly journals Clinical features and outcomes of new daily persistent headache in patients in China and comparison with medication-overuse headache: A double-center retrospective study

2020 ◽  
Author(s):  
Huanxian Liu ◽  
Ye Ran ◽  
Liang Dang ◽  
Ruirui Yang ◽  
Shuping Sun ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Clinical Features ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Mainland China ◽  
Clinical Information ◽  
Trigger Factors ◽  
Male Predominance ◽  
Younger Age ◽  
Persistent Headache

Abstract Background: This study examined the clinical features and outcomes of NDPH patients and comparison with medication-overuse headache (MOH) in mainland China.Methods: This retrospective study observed patients with NDPH and medication-overuse headache (MOH) visiting two outpatient clinics between November 2011 and December 2019. Clinical information was collected and all patients were followed by telephone.Results: The study recruited 73 NDPH and 638 MOH patients. The NDPH patients included 39 males (53.4%) and 34 females (46.6%), with an average age of 37.4 years and average headache duration of 10.6 years. Headache-precipitating factors included infection (15.1%) and stress (30.1%). Compared to MOH patients, NDPH patients had a male predominance (53.4% vs. 22.6%, p<0.001), younger age of CDH onset (26.7±12.3 vs. 41.4±11.3 years, p<0.001), and longer duration of CDH (10.6±11.8 vs. 6.1±6.2 years, p=0.023). Of the 62 NDPH patients followed up for 31 months, on average, therapeutic responses were more effective in NDPH patients with trigger factors than in those without trigger factors (71.4% vs. 32.4%; p = 0.002); the odds ratio (OR) of an effective outcome was 5.25 (1.73-17.84, p = 0.005).Conclusions: NDPH is significantly different from MOH, with a male predominance, younger age of CDH onset, and longer duration of CDH. The presence of trigger factors is an independent predictor of better treatment effect in NDPH patients.

scholarly journals Medication Overuse and Headache Burden: Results From the CaMEO Study

2021 ◽  
pp. 10.1212/CPJ.0000000000001037
Author(s):  
Todd J. Schwedt ◽  
Dawn C. Buse ◽  
Charles E. Argoff ◽  
Michael L. Reed ◽  
Kristina M. Fanning ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Chronic Migraine ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Urgent Care ◽  
Systematic Sampling ◽  
Factors Associated ◽  
Link Type ◽  
Increased Risk ◽  
Preventive Medication

AbstractObjective:To estimate the relative frequency of acute medication overuse (AMO) among people with episodic migraine (EM) and chronic migraine (CM), to characterize the types of acute medications overused for migraine, and to identify factors associated with AMO.Methods:We analyzed data from the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study (ClinicalTrials.gov, NCT01648530), a cross-sectional and longitudinal Internet study that included a systematic sampling of the US population. From September 2012 to November 2013, the CaMEO Study respondents participated in different modules to collect data on the clinical course of migraine, family burden, barriers to care, endophenotypes, and comorbidities. Among people who met criteria for migraine consistent with the International Classification of Headache Disorders, 3rd edition (ICHD-3), we evaluated types and frequency of medications used for headache/migraine, selected comorbidities, and emergency department (ED) and urgent care (UC) use. AMO was defined by days/month of medication use as specified by ICHD-3 criteria for medication overuse headache (MOH) without the requirement for ≥15 monthly headache days (MHDs). Nested, multivariable binary logistic regression modeling was used to identify factors associated with increased risk of AMO.Results:Of 16,789 CaMEO respondents with migraine, 2,975 (17.7%) met AMO criteria. Approximately 67.9% (2,021/2,975) of AMO respondents reported <15 MHDs. Simple analgesics, combination analgesics, and opioids were the medication classes most commonly overused. Factors associated with AMO in the final multivariable logistic regression model included ≥15 MHDs, moderate to severe disability, severe migraine interictal burden, use of preventive medication, and an ED/UC visit for headache within 6 months.Conclusions:Approximately two-thirds of respondents with AMO reported <15 MHDs and therefore did not meet criteria for MOH. Those with AMO had greater disease burden and increased ED/UC utilization relative to people with migraine but not AMO.

scholarly journals Clinical features and outcomes of new daily persistent headache in patients in China and comparison with medication overuse headache: a double-center retrospective study

Pain medicine ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. 10-20
Author(s):  
Huanxian Liu ◽  
Ye Ran ◽  
Liang Dang ◽  
Ruirui Yang ◽  
Shuping Sun ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Clinical Features ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Mainland China ◽  
Clinical Information ◽  
Trigger Factors ◽  
Male Predominance ◽  
Younger Age ◽  
Persistent Headache

Background: This study examined the clinical features and outcomes of NDPH patients and comparison with medication-overuse headache (MOH) in Mainland China. Methods: This retrospective study observed patients with NDPH and medication-overuse headache (MOH) visiting two outpatient clinics between November 2011 and December 2019. Clinical information was collected and all patients were followed by telephone. Results: The study recruited 73 NDPH and 638 MOH patients. The NDPH patients included 39 males (39/73, 53.4%) and 34 females (34/73, 46.6%), with an average age of 37.4 years and average headache duration of 10.6 years. Headache-precipitating factors included infection (11/73, 15.1%) and stress (22/73, 30.1%). Compared to MOH patients, NDPH patients had a male predominance (53.4% vs. 22.6%, p<0.001), younger age of CDH onset (26.7±12.3 vs. 41.4±11.3 years, p<0.001), and longer duration of CDH (10.6±11.8 vs. 6.1±6.2 years, p=0.023). In 62 NDPH patients followed up for 31 months, on average, therapeutic responses were more effective in NDPH patients with trigger factors than in those without trigger factors (71.4% vs. 32.4%; p = 0.002); the odds ratio (OR) of an effective outcome was 5.25 (1.73–17.84, p = 0.005). Conclusions: NDPH is significantly different from MOH, with a male predominance, younger age of CDH onset, and longer duration of CDH. The presence of trigger factors is an independent predictor of better treatment effect in NDPH patients.

scholarly journals Patients with sudden onset headache not meeting the criteria of the International Headache Society for new daily persistent headache. How to classify them?

2011 ◽  
Vol 69 (6) ◽  
pp. 928-931 ◽  
Author(s):  
Paulo Hélio Monzillo ◽  
Patrícia Homsi Nemoto
Keyword(s):  
Migraine Attack ◽  
International Headache Society ◽  
Sudden Onset ◽  
Primary Headaches ◽  
New Daily Persistent Headache ◽  
History Of ◽  
Group 2 ◽  
Headache Clinic ◽  
Persistent Headache ◽  
Group 1

We conducted a retrospective analysis of the records of 1348 patients regularly treated at the headache clinic of Department of Neurology of Santa Casa de São Paulo, Brazil. Sixty-two patients reported history of daily and persistent headache. From the 62 patients selected, only 21 (group 1) could be diagnosed with new daily-persistent headache (NDPH) according to the International Headache Society (HIS) 2004 criteria. The 41 remaining patients (group 2) could not be diagnosed with NDPH according to IHS-2004 once they presented two or more migraine attack-related symptoms, such as: nausea, photophobia, phonophobia and vomiting, in different combinations. It was not possible to classify them in groups 1 to 4 of primary headaches either. How to classify them? We suggest that the criteria are revised. And one way we can classify them, would be the subdivision: NDPH with migraine features and without migraine features that would allow the inclusion of all individuals present who has a daily and persistent headache from the beginning

Prevalence of right-to-left shunts on transcranial Doppler in chronic migraine and medication-overuse headache

Cephalalgia ◽  
2013 ◽  
Vol 34 (1) ◽  
pp. 37-41 ◽  
Author(s):  
Song Guo ◽  
Sarvnaz Shalchian ◽  
Pascale Gérard ◽  
Michael Küper ◽  
Zaza Katsarava ◽  
...  
Keyword(s):  
Chronic Migraine ◽  
Transcranial Doppler ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Episodic Migraine ◽  
Severe Form ◽  
Cross Sectional ◽  
Headache Clinic ◽  
Chronic Headaches ◽  
Chronic Migraineurs

Background It was suggested that right-to-left shunt (RLS) may be highly prevalent in chronic migraine (CM) patients, indicating that patent foramen ovale (PFO) might be an aggravating and chronifying factor of migraine. Since a high proportion of chronic migraineurs also have medication-overuse headache (MOH), one may wonder if they have a more severe form of the disorder and more frequently a PFO. Objective The objective of this study is to determine the prevalence and grade of RLS in patients suffering from CM and MOH. Methods A cross-sectional multicenter study of air-contrast transcranial Doppler was conducted in 159 patients with CM ( n = 57) or MOH ( n = 102) attending a tertiary headache clinic. Results The prevalence of RLS in CM was 37% (11% large shunts) and in MOH patients 31% (13% large shunts). There was no difference between the two groups ( p = 0.49). Conclusion RLS prevalence in CM is within the upper range of those reported in episodic migraine without aura or in the general population, and not higher in MOH. PFO is thus unlikely to have a significant causal role in these chronic headaches.

scholarly journals Study of the use of analgesics by patients with headache at a specialized outpatient clinic (ACEF)

2015 ◽  
Vol 73 (7) ◽  
pp. 586-592 ◽  
Author(s):  
Olga Francis Pita Chagas ◽  
Fabiola Dach Éckeli ◽  
Marcelo E. Bigal ◽  
Mayko Olinto Amaral da Silva ◽  
Jose Geraldo Speciali
Keyword(s):  
Outpatient Clinic ◽  
Migraine Without Aura ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Population Level ◽  
Final Diagnosis ◽  
Analgesic Drugs ◽  
Inflammatory Drugs ◽  
Headache Clinic ◽  
Headache Patients

Objective : To evaluate the use of analgesics in headache diagnosed in Outpatients Headache Clinic (ACEF), as well as his involvement in the activities of the patients. Method : 145 patients with headache seen at ACEF during the period August/July 2009/2010 underwent a questionnaire and interview with neurologist responsible for the final diagnosis according to ICHD-II. Results : Relationship Women:Men 7:1. 1) Prevalence: Migraine without aura (52.4%), migraine with aura (12.4%), chronic migraine (15.2%) and medication overuse headache (MOH) (20%). 2) Analgesic drugs used: Compounds with Dipyrone (37%), Dipyrone (23%), Paracetamol (16%) compound with Paracetamol (6%), triptans (6%) and non steroidal anti-inflammatory drugs (12%). There was a significant decrease in the duration of pain and less interference in the activities of the headache patients after the use of analgesics. Conclusion : Prevalence of MOH has been increasing in population level and specialized services. New studies emphasizing the MOH are needed to assist in the improvement of their diagnostic and therapeutic approach.

scholarly journals The long and winding road: the journey taken by headache sufferers in search of help

2018 ◽  
Vol 20 ◽  
Author(s):  
Paul T.G. Davies ◽  
Russell J.M. Lane ◽  
Theresa Astbury ◽  
Manuela Fontebasso ◽  
Jill Murphy ◽  
...  
Keyword(s):  
Primary Care ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Headache Disorder ◽  
Tertiary Referral Centre ◽  
Headache Diagnosis ◽  
Headache Management ◽  
Seeking Help ◽  
Benign Nature ◽  
Headache Clinic

AbstractAimTo outline the pathways a cohort of first attendees to our headache clinics had taken over the years in search of explanations and treatment for their headaches. To establish a greater awareness of the shortcomings and failures in their medical journey in the hope that better headache management will emerge in primary care.BackgroundAt first attendance in primary care most headache sufferers will not receive a firm diagnosis. Treatments provided are often ineffective and so many patients embark on a somewhat random self-made journey searching for a remedy. If they reach a Headache Clinic the most common diagnoses are ‘chronic migraine’ and ‘medication overuse headache’. They are either no better or worse than when their headaches first started despite their efforts.MethodWe undertook a prospective questionnaire-based study of over 200 patients on first attendance at each of our headache clinics, three based in District General Hospitals and one in a tertiary referral centre. We documented the patients’ headache characteristics, the ‘burden’ of their headaches, functional handicap and the financial costs incurred seeking help before referral. We also documented what our patients understood about their headache disorder and the treatments previously tried.FindingsMost patients had not been given a formal diagnosis in primary care and many remained unconvinced of the benign nature of their headache problem and wanted further investigations. A few had sought help from headache charities. Many had unrealistic attitudes to their problem and medication overuse was rife. A few patients had been offered triptans in primary care. Key deficiencies in the primary care management of these patients included failure to provide a formal headache diagnosis, inadequate understanding of the nature and mechanism of headaches and failure to follow a resilient management strategy. We provide a more effective management pathway in primary care.

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