Constant headache
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Understanding Constant Headache: Causes and Insights
Constant headaches can be a debilitating condition with various underlying causes. This article synthesizes research findings to provide a comprehensive understanding of the potential etiologies and characteristics of constant headaches.
New Daily Persistent Headache (NDPH)
Characteristics and Challenges
New daily persistent headache (NDPH) is a type of headache that begins suddenly and persists daily without remission. A case study of a 66-year-old man highlighted the challenges in managing NDPH, as the patient experienced a mild, constant holocephalic pressure with photophobia and phonophobia, but no nausea or migraine aura-like symptoms. Despite trying multiple preventive migraine medications, including onabotulinumtoxinA injections, nortriptyline, gabapentin, and metoprolol, the patient found no relief.
Thunderclap Headache
Sudden and Severe Onset
Thunderclap headaches are characterized by a sudden onset of severe pain. A 21-year-old woman experienced a new type of headache with a sudden onset, maximum intensity immediately, and localized pain at the vertex. This type of headache, described as "constant and severe," lacked migrainous features such as nausea, photophobia, or phonophobia.
Spontaneous Dural Carotid-Cavernous Fistula
Case Study Insights
A 59-year-old woman presented with a new onset of constant daily right-sided throbbing temporal headache. Initially mild, the headache's intensity increased over time. The patient experienced a variety of symptoms, including a loud roaring constant pulsatile tinnitus in the right ear, but no visual aura or other common headache-associated symptoms.
Headache in Children and Adolescents
Prevalence and Impact
Headaches are common in children and adolescents, with significant tension or migraine headaches affecting 21% of children by age 15. Chronic headaches can lead to missed school days and impact daily activities. A study emphasized the need for an organized approach to diagnosis and treatment to manage this prevalent issue effectively.
Tension-Type Headaches (TTH)
Characteristics and Treatment
Tension-type headaches are generally characterized by dull, constant, nonpulsatile pain, often described as a "headband" distribution. These headaches can be episodic or chronic, with chronic TTH occurring more than 15 times a month for at least six months. Treatment options include stress-reduction techniques, mild analgesics, muscle relaxants, and in some cases, antidepressants.
Headache as a Symptom of Brain Tumors
Critical Reappraisal
Headaches can be an early or late symptom of brain tumors, depending on the tumor's location. Constant, progressively increasing pain or a change in headache character may indicate a brain tumor. However, it is important to note that most persistent or severe headaches are not due to tumors.
Innovative Treatments
rTMS for Mild TBI-Related Headaches
Repetitive transcranial magnetic stimulation (rTMS) has shown promise in alleviating headaches related to mild traumatic brain injury (MTBI). A case series demonstrated significant reductions in headache intensity and frequency following rTMS treatment, suggesting it as a potential non-invasive therapy for chronic headache management.
Conclusion
Constant headaches can arise from various conditions, including NDPH, thunderclap headaches, spontaneous dural carotid-cavernous fistula, and tension-type headaches. Understanding the specific characteristics and underlying causes is crucial for effective diagnosis and treatment. Innovative treatments like rTMS offer new hope for patients with chronic headaches, highlighting the importance of continued research and personalized care approaches.
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