Clinical Characteristics of Chronic Daily Headache Patients Visit to University Hospital

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1 Clinical Characteristics of Chronic Daily Headache Patients Visit to University Hospital Jin-Kuk Do, M.D., Hee-Jong Oh, M.D., Dong-Kuck Lee, M.D. Department of Neurology, Taegu Hyosung Catholic University School of Medicine Background : Chronic daily headache(cdh) could be included all of the primary headache disorders with daily or near-daily headache lasting more than 4 hours/day for 15 days/month. Several studies have shown that patients with CDH are difficult to classify using the currently published International Headache Society(IHS) system. Recently, some authors recommended that CDH could be subclassified into transformed migraine(tm), chronic tension-type headache(ctth), new daily persistent headache(ndph) and hemicrania continua(hc). Methods : We analysed 100 patients with CDH who were diagnosed in Taegu-Hyosung Catholic University Hospital from February 1996 to May To describe clinical features of CDH, we used our CDH protocol. Results : (1) Most of the patients were in their 5th ~ 7th decades, and female was predominantly affected(female to male ratio, 7.3:1). (2) The subclassification of CDH were CTTH in 59 patients, TM in 33 patients, NDPH in 7 patients, and HC in 1 patient. (3) Clinical characteristics of CDH were mostly bilateral location, mild to moderate intensity and dull nature. The mean onset age of CDH was 47.7 years, the onset time of the day was in the afternoon or anytime, the duration was more than 4 hours or 12 hours in 90 patients, and the frequency was near-daily or daily in 80 patients. Common associated symptoms were nausea, dizziness, insomnia, fatigue, photophobia, blurred vision, and scalp tenderness. (4) Daily use of analgesics was reported in 66 patients. CDH was aggravated during premenstrual period in 10 patients. Positive family history was shown in 26 patients. Conclusions : We present this report because knowledge of clinical characteristics and adequate protocol for CDH in clinical practice is necessary. J Kor Neurol Ass 17(1):38~44, 1999 Key Words : Chronic daily headache, Subclassification, Clinical features, Protocol Jin-Kuk Do, M.D. 38 Copyright 1999 by the Korean Neurological Association

2 Figure 1. Protocol of chronic daily headache(cdh) J Kor Neurol Ass / Volume 17 / January,

3 Table 1. Age of onset in primary headache and CDH Age() Primary headache() CDH() Total J Kor Neurol Ass / Volume 17 / January, 1999

4 Table 2. Associated symptoms of CDH (n=100) Symptoms Patients() J Kor Neurol Ass / Volume 17 / January,

5 42 J Kor Neurol Ass / Volume 17 / January, 1999

6 11. Headache Classification Committee of the International Headache Society. Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Cephalalgia 1988;8(suppl 7): Mathew NT, Reuveni U, Perez F: Transformed or evolutive migraine. Headache 1987;27: Solomon S, Lipton RB, Newman LC. Evaluation of chronic daily headache - comparison to criteria for chronic tension-type headache. Cephalalgia 1992;12: Silberstein SD, Lipton RB, Sliwinski M. Classification of daily and near-daily headaches: Field trial of revised IHS criteria. Neurology 1996;47: Manzoni GC, Granella F, Sandrini G, Antonaci F, Zanferrari C, Nappi G. A computerized record chart for the study of chronic daily headache. Functional Neurol 1993;8: Silberstein SD, Lipton RB. Chronic daily headache. I n : Goadsby PJ, Silberstein SD, eds. Blue books of practical neurology. vol 17. Headache. Washington: Butterworth- Heinemann, 1997; ;15: Manzoni GC, Micieli G, Granella F, Martignoni E, Malferrari G, Nappi G. Daily chronic headache: Classification and clinical features: Observation on 250 patients. Cephalalgia 1987;7(suppl 6): Vanast WJ, Diaz-Mitoma F, Tyrrell DLJ: Hypothesis: Chronic benign daily headache is an immune disorder with a viral trigger. Headache 1987;27: Solomon S, Lipton RB, Newman LC. Clinical features of chronic daily headache. Headache 1992;32: Silberstein SD, Lipton RB, Solomon S, Mathew NT. Classification of chronic daily and near daily headaches: Proposed revisions to the IHS criteria. Headache 1994;34: Gladstein J, Holden EW. Chronic daily headache in children and adolescents: a 2-year prospective study. H e a d a c h e 1996 ; 35 : Srikiatkhachorn A, Phanthumchinda K. Prevalence and clinical features of chronic daily headache in a headache clinic. Headache 1997;37: Silberstein SD, Silberstein JR. Chronic daily headache: long-term prognosis following inpatient treatment with repetitive IV DHE. Headache 1992;32: Mathew NT. Chronic refractory headache. N e u r o l o g y 1993;43(suppl 3):S26-S Vanast WJ. New daily persistent headache: Definition of a benign syndrome. Headache 1986;26: Bordini C, Antonaci F, Stovner LJ, Schrader H, Sjaastad O. Hemicrania continua : A clinical review. H e a d a c h e 1991;31: Newman LC, Lipton RB, Solomon S. Hemicrania continua: 7 new cases and a literature review. Headache 1993; J Kor Neurol Ass / Volume 17 / January,

7 32: ;15: ;15: Fusco BM, Colantoni O, Ciacovazzo M. Alteration of central excitation circuits in chronic headache and analgesic misuse. Headache 1997;37: Mathew NT, Kurman R, Perez F: Drug induced refractory headache - Clinical features and management. H e a d a c h e 1990;30: Mathew NT. Drug-induced headache. In: Mathew NT, eds. Neurologic Clinics. vol 8. Philadelphia: W. B. Saunders company, 1990; Mathew NT. Transformed migraine, analgesic rebound, and other chronic daily headaches. In: Mathew NT, eds. Neurologic Clinics. vol 15. Philadelphia: W. B. Saunders company, 1997; Rasmussen BK. Epidemiology of headache. C e p h a l a l g i a 1995;15: Kudrow L. Paradoxical effects of frequent analgesic use. In: Critchley M, Friedman A, Corini S, eds. Advances in neurology, vol 33. New York, Raven Press, 1982; Mathew NT, Stubits E, Nigam MP. Transformation of episodic migraine into daily headache: Analysis of factors. Headache 1982;22: Saper J. Daily chronic headache. In: Mathew NT, eds. Neurologic Clinics. vol 7. Philadelphia: W. B. Saunders company, 1990; Sheftell FD. Chronic daily headache. Neurology 1992;42 (suppl 2): Rapoport AM, Stang P, Gutterman DL, Cady R, Markley H, Weeks R, et al. Analgesic rebound headache in clinical practice: Data from a physician survey. Headache ; 36: Diener HC, Haab J, Peters C, Ried S, Dichgans J, Pilgrim A. Subcutaneous sumatriptan in the treatment of headache during withdrawal from drug-induced headache. H e a d a c h e ; 3 1 : Saper JR, Silberstein SD, Lake AE, Winters ME. Doubleblind trial of fluoxetine: Chronic daily headache and migraine. Headache 1994;34: Bussone G, Sandrini G, Patruno G, Ruiz L, Tassorelli C, Nappi G. Effectiveness of fluoxetine on pain and depression in chronic headache disorders. In: Nappi G, Bono G, Sandrini G, et al, eds. Headache and Depression: Serotonin pathways as a common clue. New York: Raven Press, 1991 ; Foster CA, Bafaloukos J. Paroxetine in the treatment of chronic daily headache. Headache 1994;34: Mathew NT, Ali S. Valproate in the treatment of persistent chronic daily headache. An open label study. H e a d a c h e ; 3 1 : Vijayan N, Spillane T. Valproic acid treatment of chronic daily headache. Headache 1995;35: J Kor Neurol Ass / Volume 17 / January, 1999

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