Constant headaches everyday
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Understanding Constant Headaches Every Day: Insights from Recent Research
New Daily Persistent Headache (NDPH): A Complex Syndrome
Heterogeneous Nature of NDPH
New daily persistent headache (NDPH) is increasingly recognized as a heterogeneous syndrome rather than a single primary headache disorder. Various specific triggers can lead to NDPH-like presentations, complicating the diagnosis and treatment. Identifying and removing specific triggers may offer clinical improvement, although these triggers often remain unknown for many patients.
Clinical Presentation and Diagnosis
NDPH typically presents with a sudden onset of headache that persists without remission. Patients can often pinpoint the exact date their headache started. The pain is constant and may have migraine features, but it generally lacks special characteristics. Diagnosis is primarily clinical, based on patient history, but laboratory investigations are necessary to exclude secondary causes.
Epidemiology and Phenotype
The prevalence of NDPH is estimated to be between 0.03% and 0.1% in the general population, with higher rates in children and adolescents. In 67% of cases, NDPH exhibits a chronic migraine phenotype, but it is less likely than chronic migraine to be associated with a family history of headache or medication overuse .
Chronic Daily Headache: A Broader Category
Subtypes and Classification
Chronic daily headache (CDH) can be subdivided into transformed migraine, chronic tension-type headache, hemicrania continua, and NDPH. Using revised criteria, researchers have been able to classify 100% of patients in a study, with the majority having transformed migraine.
Case Studies and Clinical Reasoning
Case studies highlight the variability in CDH presentations. For instance, a 36-year-old woman with a history of migraines experienced daily headaches for a year, with severe episodes twice a week. Despite taking multiple medications, she found minimal relief. Another case involved a 66-year-old man with a new daily headache that began acutely without clear triggers, resistant to various preventive treatments.
Stress and Headache: A Significant Correlation
Impact of Stress on Headache Disorders
Both mental/cognitive stress and daily stress are linked to increased pain perception and the development of headaches, particularly in migraine and tension-type headache patients. Stress management may therefore be a crucial component in treating these conditions.
Treatment Challenges and Strategies
Limited Efficacy of Treatments
NDPH is one of the most treatment-refractory primary headache disorders. Common prophylactic drugs often fail, and even aggressive treatments like ketamine infusion, onabotulinum toxin type A, and intravenous lidocaine are usually ineffective.
Coping Strategies in Adolescents
Adolescents with chronic tension-type headaches use both problem-focused and emotion-focused strategies to cope with their pain. Regular meals, sufficient sleep, rest, relaxation, and low-intensity physical activity are perceived as beneficial.
Conclusion
Constant headaches every day, particularly those classified under NDPH and CDH, present significant diagnostic and treatment challenges. The heterogeneous nature of these headaches necessitates a tailored approach to each patient, considering potential triggers, stress factors, and individual coping strategies. Further research is essential to better understand the pathophysiology and develop effective treatments for these debilitating conditions.
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