Chronic Headache (eBook)

Mark W. Green MD, FAAN Professor of Neurology, Anesthesiology, and Rehabilitation MedicineDirector of Headache and Pain MedicineIcahn School of Medicine at Mt SinaiRobert Cowan, MDDirector, Stanford Headache and Facial Pain ClinicDepartment of Neurology & Neurological SciencesStanford School of MedicineStanford, CA Frederick G. Freitag, DOAssociate Professor NeurologyMedical College of WisconsinMilwaukee, WI

Preface 6
Contents 7
Contributors 9
1: Chronic Daily Headache: Do We Know It When We See It? 13
Definition 13
Introduction 13
Epidemiology 13
Pathophysiology 14
Diagnosis and Classification of Chronic Daily Headache 14
Chronic Migraine 14
Diagnostic Criteria for Chronic Migraine 14
Treatment 15
Chronic Tension-Type Headache 16
Diagnostic Criteria 16
Treatment of Chronic Tension-Type Headache 16
Hemicrania Continua 17
Diagnostic Criteria 17
Treatment of Hemicrania Continua 17
Chronic Cluster Headache 17
Diagnostic Criteria 18
Treatment of Chronic Cluster Headache 18
New Daily Persistent Headache 19
Diagnostic Criteria 19
Treatment of NDPH 19
Non-Pharmacologic Treatment for Chronic Daily Headache 20
Discussion 20
References 21
2: Refractory Headache or Refractory Patient? Issues of Locus of Control in Chronic Daily Headache (CDH) 23
Introduction 23
Locus of Control 23
Locus of Control Defined 23
Health LOC 24
Headache-Specific LOC 24
Self-Efficacy 26
Psychosocial Interventions for CDH: Cognitive-Behavioral Therapy and Motivational Interviewing 27
Cognitive-Behavioral Therapy 27
Biofeedback and Assessments 28
Headache-Specific Locus of Control (HSLC) Scale 29
Headache Management Self-Efficacy (HMSE) Scale 29
Pain Catastrophizing Scale (PCS) 29
Motivational Interviewing 29
LOC and SE: Suggestions for the Provider 31
Case Study 32
References 34
3: Collecting the History in the CDH Patients 37
Classification of Chronic Daily Headache (CDH) 38
Chronic Primary Headaches 38
Primary CDH of Long Duration 38
Chronic Migraine (CM) 38
Chronic Tension-Type Headache (CTTH) 38
Hemicrania Continua (HC) 39
New Daily Persistent Headache (NDPH) 39
Nummular Headache (NH) 39
Primary CDHs of Short Duration 39
Chronic Cluster Headache (CCH) 40
Chronic Paroxysmal Hemicranias (CPH) 40
Chronic Short-Lasting Unilateral Neuralgiform Headache Attacks 40
Hemicrania Continua (HC) 40
Hypnic Headache (HH) 41
Primary Stabbing Headache (PSH) 41
Secondary Chronic Daily Headaches 41
CDH Attributed to Trauma 41
Persistent Headache Attributed to Traumatic Injury to the Head 41
CDH Attributed to Cranial Vascular Disorders 41
CDH Attributed to Giant-Cell Arteritis (GCA) 41
Chronic Headache Attributed to Reversible Cerebral Vasoconstriction Syndrome (RCVS) 42
CDH Attributed to Intracranial Nonvascular Disorders 42
Chronic Headache Attributed to Increased Cerebrospinal Fluid Pressure 42
Chronic Headache Attributed to Low Cerebrospinal Fluid Pressure/Volume 42
Chronic Headache Attributed to Intracranial Neoplasia 43
Chronic Headache Attributed to Chiari Malformation Type I (CM1) 43
Chronic Headache Attributed to Noninfectious Inflammatory Disease 43
CDH Attributed to Long-Term Use of Medications 43
Chronic Headache Attributed to Long-Term Use of Non-Headache Medication 43
Medication-Overuse Headache (MOH) 43
CDH Attributed to Infections 44
CDH Attributed to Intracranial Infections 44
CDH Attributed to Systemic Infections 44
CDH Attributed to Disorders of Homeostasis 44
Chronic Headache Attributed to Sleep Apnea 44
Chronic Headache Attributed to Hypothyroidism 44
Chronic Headache Attributed to Disorder of Cranial Bone 44
Cervicogenic Headache 44
Chronic Headache Attributed to Retropharyngeal Tendonitis 45
Chronic Headache Attributed to Craniocervical Dystonia 45
Chronic Headache Attributed to Chronic or Recurring Rhinosinusitis 45
Chronic Headache Attributed to Temporomandibular Disorder (TMD) 45
Chronic Headache Attributed to Other Disorders of the Cranium, Neck, Eyes, Ears, Nose, Sinuses, and Teeth 45
CDH Headache Attributed to Psychiatric Disorders 45
Chronic Headache Attributed to Somatization Disorder (Currently Somatic Symptom Disorder in DSM-5) 45
Painful Cranial Neuropathies and Other Facial Pains 46
Classical Trigeminal Neuralgia 46
Postherpetic Trigeminal Neuropathy (Trigeminal PHN) 46
Chronic Occipital Neuralgia 46
Burning Mouth Syndrome (BMS) 46
Persistent Idiopathic Facial Pain (PIFP) 46
Chronic Central Poststroke Pain (CPSP) 47
References 47
4: Chronic Migraine: Epidemiology, Mechanisms, and Treatment 49
Chronic Migraine: Diagnosis and Classification 49
Epidemiology and Impact 51
Pathophysiology 52
Management and Treatment 56
Established and Emerging Pharmacological Treatments 57
Topiramate 57
OnabotulinumtoxinA 59
Monoclonal Antibodies to the Calcitonin Gene-Related Peptide or Its Receptor 62
Nonpharmacological Treatments and Other Interventions 65
Acupuncture 65
Behavioral Therapy 65
Peripheral Neurostimulation for Chronic Migraine 66
Peripheral Nerve Blockade 67
Refractory Chronic Migraine and Clinical Trial Considerations 67
References 68
5: Yogi’s Headache: Chronic Tension-Type Headache 75
Tension-Type Headache as a Spectrum 77
Tension-Type Headache Pathophysiology and Clinical Findings 78
Fundamentals 78
Differences Between ETTH and CTTH 78
Chemical 79
Pericranial Tenderness 79
Pain Pressure Point 79
Myofascial Trigger Points 79
Neuroplastic Changes and Central Sensitization 80
Stress and Genetics 80
Tension-Type Headache Clinical Issues 81
Tension-Type Headache Clinical and Physical Findings 81
Secondary Headache 81
Cervicogenic 81
Comorbidities 81
Mood/Behavioral 82
ETT/CTTH Treatment 82
Acute Treatment 82
Prophylactic 82
Procedural Interventions 83
Behavioral Therapy 84
References 84
6: Chronic Cluster Headaches 89
Epidemiology 89
Clinical Features 90
Differential Diagnosis 91
Secondary Cluster Headaches 94
Pathophysiology and Imaging Studies 95
Treatment 96
Management of Acute Attacks 96
Oxygen 96
Triptans 97
Ergotamine Derivatives 97
Lidocaine 97
Octreotide 97
Indomethacin 98
Other Drugs 98
Greater Occipital Nerve (GON) Injection 98
Long-Term Prophylactic Treatments 98
Verapamil 98
Lithium 99
Melatonin 99
Corticosteroids 99
Triptans 99
Antiepileptics 100
Antihistaminics 101
Intranasal Agents 101
Interventional and Surgical Treatment 101
Sphenopalatine Ganglion (SPG)-Targeted Procedures 101
Trigeminal Ganglion-Targeted Therapy 102
Occipital Nerve-Targeted Therapy 102
Vagus Nerve-Targeted Therapy 103
Hypothalamic-Targeted Therapy 103
The Cluster Patient Perspective 103
References 103
7: New Daily Persistent Headache 109
Introduction 109
Epidemiology 109
Diagnostic Criteria 110
Clinical Features 110
Etiology and Pathophysiology 111
Triggering Events 112
Flu-Like Illness or Infection 112
Stressful Event 112
Surgical Procedure 112
Differential Diagnosis 112
Primary Headache Disorders 113
Secondary Headaches (NDPH Mimics) 113
Spontaneous Intracranial Hypotension 113
Cerebral Venous Thrombosis 114
Idiopathic Intracranial Hypertension 114
Viral Meningitis 114
Reversible Cerebral Vasoconstriction Syndrome 114
Sphenoid Sinusitis 115
Cervical and Vertebral Artery Dissections 115
Giant Cell Arteritis 115
Contact Point Headache 115
Systemic Illness 115
Other 115
Evaluation 116
Treatment 116
Pharmacologic Treatment 117
Antiepileptics 117
Antidepressants 117
Tetracycline Derivatives 117
Leukotriene Antagonists 117
Sodium Channel Blockers 117
Corticosteroids 117
Dihydroergotamine 118
Interventional Procedures 118
Nerve Blocks 118
Botulinum Toxin 118
Other Agents 118
Emerging Therapies 119
Naltrexone 119
Naratriptan 119
Prazosin 119
Diet and Lifestyle 120
Treatment Approach 120
Prognosis 120
References 121
8: Chronic Secondary Headaches 124
Overview and Clinical Assessment 124
Secondary Chronic Headache Disorders 125
Headache Attributed to Trauma or Injury to the Head and/or Neck 125
Headaches Following Head Injury 126
Headaches Following Neck Injury 127
Headaches Following Craniotomy 127
Headache Attributed to Cranial or Cervical Vascular Disorder 128
Ischemic or Hemorrhagic Stroke 128
Cerebral Venous Thrombosis 128
Cerebral Aneurysm 128
Vascular Malformation 128
Cervicocephalic Artery Dissection 129
Giant Cell Arteritis 129
Nonvascular Intracranial Disorders 129
Intracranial Hypertension 129
Intracranial Hypotension 130
Brain Tumor 131
Chiari Malformation 131
Substances 132
Intracranial Infection 132
Miscellaneous 132
References 133
9: Chronic Facial Pain and Other Chronic Neuralgias 136
Trigeminal Neuralgia 136
Introduction 136
Epidemiology 136
Etiology 136
Pathogenesis 137
Classification and Clinical Presentation: 137
Medical Management 139
Surgical Management 141
Glossopharyngeal Neuralgia 142
Introduction 142
Epidemiology 142
Etiology 142
Clinical Presentation and Diagnostic Criteria 142
Medical Management 143
Surgical Management 143
Nervus Intermedius Neuralgia 143
Introduction 143
Classification 143
Epidemiology, Etiology, and Clinical Diagnostic Criteria 143
Medical Management 144
Surgical Management 144
Occipital Neuralgia 145
Introduction 145
Epidemiology 145
Etiology 145
Clinical Presentation and Diagnostic Criteria 145
Management 146
Optic Neuritis 146
Introduction 146
Epidemiology 146
Etiology 146
Clinical Presentation and Diagnostic Criteria 147
Management 147
Headache Attributed to Ischemic Ocular Motor Nerve Palsy 147
Introduction 147
Etiology 147
Clinical Presentation and Diagnostic Criteria 147
Management 148
Recurrent Painful Ophthalmoplegic Neuropathy 148
Introduction 148
Epidemiology 148
Etiology 148
Clinical Presentation and Diagnostic Criteria 148
Management 149
Tolosa-Hunt Syndrome 149
Introduction 149
Epidemiology 149
Etiology 149
Clinical Presentation and Diagnostic Criteria 150
Management 150
Paratrigeminal Oculosympathetic (Raeder’s) Syndrome 150
Introduction 150
Epidemiology 150
Etiology 150
Clinical Presentation and Diagnostic Criteria 150
Management 151
Burning Mouth Syndrome 151
Introduction 151
Epidemiology 151
Etiology 151
Clinical Presentation and Diagnostic Criteria 151
Management 152
Pain 152
Introduction 152
Epidemiology 152
Etiology 152
Clinical Presentation and Diagnostic Criteria 152
Management 153
Central Neuropathic Pain 153
Introduction 153
Pathogenesis 153
Classification 153
Epidemiology, Etiology, and Clinical Presentation and Diagnostic Criteria 153
Management 154
References 155
10: CDH in Pediatric and Adolescent Patients 158
Introduction 158
Epidemiology 159
Risk Factors for Chronification/Progression 159
Impact 160
Treatment 161
Lifestyle Modifications 162
Non-medication Therapies 163
Medication 163
Additional Interventions 165
Prognosis 165
References 166
11: Imaging in CDH 168
Introduction 168
MRI Approaches to Study CDH 168
Structural MRI Reveals Abnormalities in the Brain Structure of CDH Patients 169
Functional Brain Abnormalities in CDH as Assessed by fMRI 173
What Other Neuroimaging Modalities Reveal About CDH 176
Future Directions for Neuroimaging Research in CDH 177
References 177
12: Laboratory Investigation in CDH 180
Introduction 180
Serological Testing 180
Complete Blood Profile 180
Complete Metabolic Profile (CMP) 181
Coagulation Studies 181
Lupus Anticoagulant, Anticardiolipin Antibodies, Protein S, Protein C, Factor VIII, Antithrombin III, and Factor V Leiden 182
D-Dimer 182
Plasma Metanephrines 182
Markers of Inflammation 182
ESR 182
CRP 183
ANA 183
Endocrine Testing 183
Thyroid Function Studies 183
Prolactin, GH, and ACTH 184
Infectious 184
Lyme 184
HIV 185
Lumbar Puncture 186
Cell Count and Differential, Protein, and Glucose 186
Opening Pressure 186
ACE 186
Cytology 187
Infectious Workup 187
TNF-Alpha 187
IGG Index and Oligoclonal Bands 188
Genetic Testing 188
CADASIL 188
MTHFR and ACE Polymorphisms 188
MELAS 189
Familial Hemiplegic Migraine 190
Special Cases 190
Pregnancy 190
Immunocompromise 190
Traumatic Brain Injury 191
Hypercoagulability States 191
References 192
13: Monitoring of Chronic Daily Headaches 195
Introduction 195
Office Visit 196
Mental Health Monitoring 197
Vitals 198
Physical Examination 199
Laboratory Assessment 200
Radiological Monitoring 200
Specialized Testing 201
Headache Diaries 201
References 202
14: Medication Overuse in Chronic Daily Headache 204
Introduction 204
Definitions 204
Diagnostic Criteria 205
Epidemiology 205
Diagnosis and Clinical Features 205
Pathophysiology 206
Risk Factors 206
Treatment 207
Preventive Migraine Therapy in MOH 208
Management of Symptoms During Detoxification 208
Relapse of MOH 211
References 212
15: Optimizing Acute Headache Treatment in the Setting of Chronic Migraine 216
The Therapeutic Paradox 216
Consequences of Inadequately Treated Acute Migraine 217
Medication Overuse Headache 217
Rational Pharmacologic Management of Acute Migraine in the CM Patient 218
Selecting a Therapy 219
Nonspecific Migraine Therapies 220
“Specific” Migraine Therapies 221
Status Migrainosus 221
References 224
16: Pharmacologic Approaches to CDH: Evidence and Outcomes 225
Introduction 225
Preventative Treatment 225
Oral Preventive Treatment: Drugs 226
Antiepileptics (Table 16.1) 226
Topiramate 226
Valproate Sodium 227
Gabapentin 227
Pregabalin 228
Zonisamide 228
Levetiracetam 228
?-Blockers (Table 16.2) 228
Propranolol 228
Atenolol 228
Tricyclic Antidepressants 228
Amitriptyline 230
Selective Serotonin Reuptake Inhibitors and Serotonin-Norepinephrine Reuptake Inhibitors 230
Fluoxetine 230
Venlafaxine 230
Duloxetine 231
Nefazodone 231
Calcium Channel Blockers 231
Flunarizine 231
Angiotensin II Receptor Blockers 231
Candesartan 231
Alpha-Blockers 231
Tizanidine 231
Other Drugs 231
Anaesthetic Blocks 231
Sphenopalatine Ganglion Blockade 231
Anaesthetic Occipital Nerve Blockade 232
Preventive Treatment with OnabotulinumtoxinA 232
How to Use it 233
How to Manage Preventive Treatment in CM 234
Future 234
References 235
17: Behavioral Approaches to CDH: Evidence and Outcomes 239
Psychological Interventions 239
Components of CBT 240
Psychological Education 240
Cognitive Strategies 240
Behavioral Strategies 240
Relaxation Techniques 240
Biofeedback and Neurofeedback 241
Evidence and Outcomes for CBT 241
Acceptance-Based Interventions 242
Healthy Habits 242
Nutrition 243
Hydration 243
Exercise 244
Sleep 244
References 244
18: Complementary and Alternative Approaches to Chronic Daily Headache: Part I—Mind/Body 247
Introduction to Parts I, II, and III: Complementary and Alternative Approaches for Chronic Daily Headache 247
Mind/Body and Chronic Daily Headache 249
Meditation 250
Potential Mechanisms of Meditation 252
Summary: Meditation and Chronic Daily Headache 253
Yoga 254
Summary: Yoga and Headache 255
Tai Chi 255
Deep Breathing 255
Summary: Mind Body and Chronic Daily Headache 256
References 256
19: Complementary and Alternative Approaches to Chronic Daily Headache: Part II—Manipulation-Based Therapies and Other CAM Therapies 260
Manipulation-Based Therapies: Overview 260
Acupuncture 260
Acupuncture and Chronic Daily Headache 260
Acupuncture and Migraine 262
Acupuncture and Tension Headache 262
Acupuncture and Cluster Headache 263
Acupuncture and Pediatric Headache 263
Acupuncture and Cost Analysis 263
Acupuncture Summary of Evidence and Recommendations 263
Acupressure 264
Dry Needling 264
Chiropractic Manipulation 265
Chiropractic Manipulation and “Chronic Daily Headache” 265
Chiropractic Manipulation and Cervicogenic Headache 265
Chiropractic Manipulation and Tension Headache 266
Chiropractic Manipulation and Migraine 267
Chiropractic Manipulation and Pediatrics 267
Chiropractic Manipulation and  Cost Analysis 268
Chiropractic Manipulation and  Adverse Events 268
Chiropractic Manipulation: Summary of Recommendations 268
Massage 269
Massage and “Chronic Headache” 269
Massage and Tension Headache 269
Massage and Migraine 270
Massage and Cervicogenic Headache 270
Massage and Pediatric Headaches 271
Massage and Cost Analysis 271
Massage and Adverse Events 271
Massage: Summary of Recommendations 271
Craniosacral Manipulation 272
Reflexology 272
Other Complementary and Alternative Treatment Approaches 272
Aromatherapy 272
Hydrotherapy 272
Daith Piercing 273
Oxygen Administration 273
Summary: Manipulation-Based and Other Therapies for Chronic Daily Headache 274
References 274
20: Complementary and Alternative Approaches to Chronic Daily Headache: Part III—Nutraceuticals 280
Nutraceuticals 280
Feverfew 281
Evidence of Feverfew for Headache 281
Feverfew Guideline Recommendations 282
Riboflavin 282
Evidence of Riboflavin for Headache 282
Riboflavin Guideline Recommendations 283
Magnesium 283
Evidence for Treatment of Headache with Magnesium 284
Magnesium Guideline Recommendations 284
Coenzyme Q10 (CoQ10) 284
Evidence for CoQ10 for Headache 285
CoQ10 Guideline Recommendations 285
Melatonin 285
Evidence for Melatonin for Headache 286
Vitamin D 286
Ginkgolide B (Ginkgo biloba) 287
Combination Treatments 287
Homeopathy 288
Summary: Supplements and Chronic Daily Headache 288
Conclusions to Parts I, II, and III: CAM and Chronic Daily Headache 288
References 291
21: Animal Models in Chronic Daily Headache (CDH) and Pathophysiology of CDH 295
Introduction of Animal CM Model 295
Anatomy (Neural Substrate and Their Connections) and CM Models from Trigeminal Nociceptive Activation 296
Neurogenic Theory of Migraine 296
Neural Circuitry Implicated in CM 296
Preclinical Behavioral Manifestations of CM Models (Aura/CSD, Allodynia/Hyperalgesia, and Sensitivity to NTG) 301
CSD and Aura 301
Allodynia and Hyperalgesia 301
Hypersensitivity to NTG 302
Treatment Assessment Based on the Symptoms 302
Electrophysiological Mechanisms and Non-pharmacological Treatment 302
Neuronal Hyperexcitability 303
Evoked Potentials (EPs) 303
CSD 303
Treatment Using Electrophysiological Approach 303
Biochemical Mechanisms and Pharmacological Treatment 304
Animal Studies Reveal Molecular Mechanisms 304
Discovery of Mechanism-Based CM Therapy 304
Genetic Models 306
Limitations of CM Animal Models 308
Summary and Conclusion 308
References 308
22: Economic Impact of Chronic Headaches 315
References 317
23: From Episodic to Chronic: A Discussion on Headache Transformation 318
Pathophysiology of Chronic Headache 319
Serotonin Receptors 319
CSF Glutamate 319
Calcitonin Gene-Related Peptide (CGRP) 319
Genetics 319
Quality of Life in CDH 320
Risk Factors for Transformation 321
Medication Overuse 321
Obesity 321
Sleep 322
Acute Stress 322
Depression 323
Menstrual-Related Migraines 324
References 324
24: Chronic Daily Headache and Comorbid Disorders 326
Introduction 326
Mood Disorders 326
Depression 327
Anxiety 327
Childhood Maltreatment 327
Post-traumatic Stress Disorder 328
Musculoskeletal Disorders 328
Temporal Mandibular Dysfunction 328
Cervicalgia 328
Connective Tissue Disorders and Pain Disorders 329
Neurological Disorders 329
Head Injury 329
Epilepsy 330
Ischemic Stroke 330
Medical Disorders 330
Thyroid Disorders 330
Sleep Disorders 331
Obesity 331
Allergic Rhinitis and Asthma 332
Irritable Bowel Syndrome and Other Gastrointestinal Disorders 333
Cardiovascular Diseases 333
References 334
25: Neurostimulation in the Management of Chronic Migraine 339
Introduction 339
Implantable Occipital Nerve Stimulation 340
Transcutaneous Supraorbital Nerve Stimulation 341
Transcranial Stimulation Methods 341
Repetitive-Pulse Transcranial Magnetic Stimulation 342
Single-Pulse Transcranial Magnetic Stimulation 342
Transcranial Direct Current Stimulation 343
Transcutaneous Vagus Nerve Stimulation 343
Sphenopalatine Nerve Stimulation 344
References 345
26: Postsurgical Headaches and Their Management 349
Anatomy 349
Craniotomy Technique 351
Postsurgical Headaches 351
Acute Headaches 351
Treatment 352
Opioid Medications 352
Acetaminophen with Codeine 352
Tramadol 352
Morphine PCA 352
Nonsteroidal Anti-inflammatory Drug (NSAID) Medications 353
Local Anesthetics 353
Dexmedetomidine 353
Chronic Headaches 353
Treatment 354
Hemicrania Continua 354
Scalp Neuralgias 355
CSF Hypotension Syndrome 355
Medication Overuse Headaches 356
Other Postsurgical Syndromes Associated with Headaches 357
Frontotemporal Brain Sagging Syndrome 357
Syndrome of the Trephine 358
Carotid Endarterectomy-Related Headaches 358
References 359
27: Chronic Daily Headache Classification 361
Introduction 361
Goals of Classification 361
History of CDH Classification 362
CDH Differential Diagnoses 363
Chronic Migraine with and Without Aura 364
Other Features 364
Epidemiology 364
Risk Factors 364
Comorbidities 365
Pathophysiology 365
Chronic Tension-Type Headache 366
Classification 366
Other Features 367
Epidemiology 367
Risk Factors 367
Comorbidities 367
Pathophysiology 367
Prognosis 368
Chronic Cluster Headache 368
Classification 368
Other Features 368
Epidemiology 369
Risk Factors 369
Comorbidities 369
Pathophysiology 369
Prognosis 370
Hemicrania Continua 370
Classification 370
Other Features 371
Epidemiology 371
Pathophysiology 371
Prognosis 372
New Daily Persistent Headache 372
Classification 372
Other Features 372
Epidemiology 372
Risk Factors 373
Comorbidities 373
Pathophysiology 373
Prognosis 373
Medication-Overuse Headache 373
Classification 374
Epidemiology 374
Risk Factors and Comorbidities 374
Pathophysiology 375
Prognosis 375
Persistent Secondary Headaches 375
Persistent Headache Attributed to Traumatic Injury to the Head 375
Classification 376
Other Features 376
Epidemiology 376
Comorbidities and Risk Factors in PTH Chronification 376
Pathophysiology 376
Prognosis 377
Chronic Daily Headache in Children and Adolescents 377
Clinical Features 377
Epidemiology 377
Chronic Daily Headache in Elderly 377
Refractory Headaches 378
Summary 379
References 379
Index 386