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Thus far, four trigger areas have been identified as surgical candidates. Three of these are in locations where the nerve passes through a muscle&mdash;where the [[greater occipital nerve]] pierces through the [[semispinalis capitis muscle]], the [[zygomaticotemporal nerve]] through the [[temporalis muscle]], and the [[supraorbital nerve|supraorbital]]/[[supratrochlear nerve|supratrochlear]] nerves through the [[glabella]]r muscle group (the [[corrugator supercilii]], [[depressor supercilii]], and [[procerus muscle]]s).<ref name="Mosser 2004">{{cite pmid|14758238}}</ref><ref name="Guyuron 2005">{{cite pmid|15622223}}</ref><ref name="Poggi 2008">{{cite doi|10.1097/PRS.0b013e31817742da}}</ref> The fourth trigger point, however, has been identified in the nose of patients who have significant [[nasal septum deviation]] with enlargement of the [[turbinate]]s.<ref name="Guyuron 2005"/> The contact between these structures causes the irritation of the [[trigeminal nerve]] end branches and thus triggers headaches. Several large series of studies have been conducted to evaluate the efficacy of surgical obliteration of trigger points. Almost all demonstrated more than 90% response, with at least 50% improvement to complete resolution of pain symptoms.
Thus far, four trigger areas have been identified as surgical candidates. Three of these are in locations where the nerve passes through a muscle&mdash;where the [[greater occipital nerve]] pierces through the [[semispinalis capitis muscle]], the [[zygomaticotemporal nerve]] through the [[temporalis muscle]], and the [[supraorbital nerve|supraorbital]]/[[supratrochlear nerve|supratrochlear]] nerves through the [[glabella]]r muscle group (the [[corrugator supercilii]], [[depressor supercilii]], and [[procerus muscle]]s).<ref name="Mosser 2004">{{cite pmid|14758238}}</ref><ref name="Guyuron 2005">{{cite pmid|15622223}}</ref><ref name="Poggi 2008">{{cite doi|10.1097/PRS.0b013e31817742da}}</ref> The fourth trigger point, however, has been identified in the nose of patients who have significant [[nasal septum deviation]] with enlargement of the [[turbinate]]s.<ref name="Guyuron 2005"/> The contact between these structures causes the irritation of the [[trigeminal nerve]] end branches and thus triggers headaches. Several large series of studies have been conducted to evaluate the efficacy of surgical obliteration of trigger points. Almost all demonstrated more than 90% response, with at least 50% improvement to complete resolution of pain symptoms.


This type of surgery is not offered as a first line of treatment, but after extensive evaluation and failure of traditional medical treatments.<ref name="Guyuron 2005"/><ref name="Guyuron 2002">{{cite pmid|12045534}}</ref><ref name="Totonchi">{{cite pmid|15622263}}</ref> Trials are still ongoing to standardize the procedures of choice for definitive management of NDPH and migraine headaches, but there have been successful guidelines for surgical therapy, which are being used by several migraine surgery specialists around the globe. http://migrainesurgeryinstitute.com/ http://americanmigrainecenter.com/ http://www.migrainereliefatlast.com/ http://www.georgetownuniversityhospital.org/body_fw.cfm?id=8&action=detail&ref=3145</ref>
This type of surgery is not offered as a first line of treatment, but after extensive evaluation and failure of traditional medical treatments.<ref name="Guyuron 2005"/><ref name="Guyuron 2002">{{cite pmid|12045534}}</ref><ref name="Totonchi">{{cite pmid|15622263}}</ref> Trials are still ongoing to standardize the procedures of choice for definitive management of NDPH and migraine headaches, but there have been successful guidelines for surgical therapy, which are being used by several migraine surgery specialists around the globe. <ref>
http://migrainesurgeryinstitute.com/ http://americanmigrainecenter.com/ http://www.migrainereliefatlast.com/ http://www.georgetownuniversityhospital.org/body_fw.cfm?id=8&action=detail&ref=3145</ref>


==Prognosis==
==Prognosis==

Revision as of 04:33, 31 January 2013

New Daily Persistent Headache (NDPH) is a distinct primary headache syndrome which can mimic chronic migraine and chronic tension-type headache. The headache is daily and unremitting from very soon after onset (within 3 days at most), in a person who does not have a past history of a primary headache disorder. The pain can be intermittent, but lasts more than 3 months.

The striking feature of the condition is its abrupt onset. Patients often remember the date, circumstance and indeed, occasionally, the time of headache onset. One retrospective study stated that over 80% of patients could state the exact date their headache began.[1]

The syndrome is difficult to treat and may persist for years.

Background

in 1986, Vanast was the first author to describe the new daily-persistent headache (NDPH) as a benign form of chronic daily headache (CDH).[2]

The criteria for the diagnosis of NDPH were proposed in 1994 (the Silberstein–Lipton criteria)[3] but not included in the International Classification of Headache Disorders (ICHD) until 2004.

The cause of NDPH is unknown, and it may have more than one etiology. NDPH onset is usually in relation to an infection or flu-like illness, stressful life event, minor head trauma, and extra cranial surgery. Infection or flu-like illness and stressful life event are most often cited.[1]

The age of onset ranges from 6 to greater than 70 years old, with a mean of 35 years. It is found to be more common in females in both the adult and pediatric populations.

NDPH is rare. The Akershus study of chronic headache, a population based cross sectional study of 30,000 persons aged 30–44 years in Norway, found a one-year prevalence of 0.03 percent in the population.[4]

The pathophysiology of NDPH is poorly understood.

Presentation

The headaches can vary greatly in their clinical presentation and duration.

Quality of the headache has been described as dull and/or pressure-like sensation, and throbbing and/or pulsating sensation. The pain is usually on both sides of the head (in 88%–93% of people with NDPH), but may be unilateral, and may be localized to any head region.[5] The pain can fluctuate in intensity and duration, is daily, and lasts more than 3 months.

There may be accompanying photophobia, phonophobia, lightheadedness or mild nausea. Co-morbidity with mood disorders has been reported in a subset of patients.

Cranial autonomic nervous symptoms occur with painful exacerbations in 21%, and cutaneous allodynia may be present in 26%.[6]

Clinical Characteristics

In 2002, Li and Rozen[1] conducted a study of 56 patients at the Jefferson Headache Center in Philadelphia and published the following results:

  • 82% of patients were able to pinpoint the exact day their headache started.
  • 30% of the patients, the onset of the headache occurred in correlation with an infection or flu-like illness.
  • 38% of the patients had a prior personal history of headache.
  • 29% of the patients had a family history of headache.
  • 68% reported nausea.
  • 66% reported photophobia.
  • 61% reported phonophobia.
  • 55% reported lightheadedness.

Imaging and laboratory testing were unremarkable except for an unusually high number of patients who tested positive for a past Epstein-Barr virus infection.

Diagnosis

Although NPDH is classified as a primary headache syndrome, it must be remembered that a number of important conditions can present with a new-onset persisting headache, and these must be excluded prior to making a diagnosis of a primary headache disorder.

The diagnosis is one of excluding the many secondary types or NDPH mimics, which is especially critical early in the course of the disease when a secondary etiology is more likely. NDPH mimics include but are not limited to:

Many doctors state that the condition is best viewed as a syndrome rather than a diagnosis.[7] Once a diagnosis of NDPH is made, clinicians argue that patients are best managed according to the more detailed pathophysiology-based diagnosis than lumped together into a single group, since a single disorder is unlikely to exist.

Diagnostic Criteria

NDPH It is classified as a Primary Headache Disorder by the ICHD-2 classification system (by the IHS) using number 4.8. It is one of the types of primary headache syndromes that present as a chronic daily headache, which is a headache present for more than 15 days a month for more than 3 months.

ICHD Diagnostic Criteria

The ICHD Diagnostic Criteria is:[8]

  1. Headache that, within 3 days of onset, fulfils criteria B-D
  2. Headache is present daily, and is unremitting, for > 3 months
  3. At least two of the following pain characteristics:
    1. bilateral location
    2. pressing/tightening (non-pulsating) quality
    3. mild or moderate intensity
    4. not aggravated by routine physical activity such as walking or climbing
  4. Both of the following:
    1. no more than one of photophobia, phonophobia or mild nausea
    2. neither moderate or severe nausea nor vomiting
  5. Not attributed to another disorder

Notes:

  1. Headache may be unremitting from the moment of onset or very rapidly build up to continuous and unremitting pain. Such onset or rapid development must be clearly recalled and unambiguously described by the patient. Otherwise it is coded as 2.3 Chronic tension-type headache.
  2. History and physical and neurological examinations do not suggest any of the disorders listed in groups 5-12 (including 8.2 medication overuse headaches and its subforms), or history and/or physical and/or neurological examinations do suggest such disorder but it is ruled out by appropriate investigations, or such disorder is present but headache does not occur for the first time in close temporal relation to the disorder.

Diagnostic Criteria Revision

Although the original Silberstein–Lipton criteria and the original description by Vanast make no suggestion for the exclusion of migrainous features in NDPH, the current ICHD criteria exclude patients with migrainous features. When migraine features are present, classification thus becomes problematic.

It has been reported that migraine symptoms may be present in over 50% of NDPH patients.[9] The current criteria definition thus excludes more than half of patients with new onset of daily headache. This exclusion due to migrainous features could have adverse scientific, diagnostic, and treatment consequences.[10]

One proposal for reclassification of the criteria is from a study conducted on retrospective analysis of the records of 1348 patients regularly treated at the headache clinic of the Department of Neurology of Santa Casa de São Paulo, Brazil, and would be the following 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.[11]

Another proposed reclassification of the criteria is from a study conducted as a retrospective chart review of patients seen at the Headache Center at Montefiore Medical Center in Bronx, New York, from September 2005 to April 2009. The revised criteria for NDPH definition does not exclude migraine features (NDPH-R), and three subdivisions were created and described based on prognosis: Persisting, remitting, and relapsing–remitting. Additionally, this revised criteria would not include parts C or D currently required by the ICHD diagnostic criteria for NDPH.[6]

Pathophysiology

The pathophysiology of NDPH is poorly understood. Research points to an immune-mediated, inflammatory process. Cervical joint hypermobility and defective internal jugular venous drainage have also been suggested as causes.[12][13]

In 1987, Vanast first suggested autoimmune disorder with a persistent viral trigger for CDH (now referred to as NDPH).[14] Post-infectious origins have been approximated to make up anywhere between 30-80% of NDPH patients in different studies. Viruses that have been implicated include Epstein-Barr virus, Herpes simplex virus and cytomegalovirus.[15][16]

Non-specific upper respiratory infections including rhinitis and pharyngitis are most often cited by patients.[17] In one study, 46.5% patients recalled a specific trigger with a respiratory tract illness being the most common. In children, almost half report headache onset during an infection.

A study by Rozen and Swindan in 2007 found elevated levels of tumor necrosis factor alpha, a proinflammatory cytokine, in the cerebrospinal fluid but not the blood of patients with NDPH, chronic migraine, and post-traumatic headaches suggesting inflammation as the cause of the headaches.[18]

NDPH as an inflammatory, post-infectious manifestation indicates a potential meningoencephalitis event in NDPH patients. Tissue specificity is a general feature of post-infectious, immune-mediated conditions, and the meninges are a type of connective tissue membrane. Inflammation of the meninges was first proposed as a possible pathophysiology for migraine in the 1960's and has recently been explored again.[19] This hypothesis is based on meningeal mast cell activation. Reactive arthritis (ReA) is a post-infectious disease entity of synovium/joints with connective tissue membrane (synovial membrane of the joints) which provides a corollary.

NDPH has been reported in Hashimoto's encephalopathy, an immune-mediated type of encephalitis.[20] A mean 5-year retrospective analysis of 53 patients with a history of viral meningitis and 17 patients with a history of bacterial meningitis showed an increased onset of subsequent new onset headache and increased severity of those with prior primary headaches.[21]

Treatment

As outlined by the ICHD, NDPH may take either of two subforms: a self-limiting subform which typically resolves without therapy within several months and a refractory subform which is resistant to aggressive treatment programmes.

There are no prospective placebo controlled trials of preventive treatment so prevention is empiric using the same medications for the phenotype of chronic migraine or chronic tension-type headache. A large proportion of NDPH sufferers have migrainous features to their headache and should be managed with treatments used for treating migraine.[22] These medications include but are not limited to:

Occipital nerve block have been anecdotally reported to be helpful for some patients with NDPH. A nerve block is a medication that is injected near a nerve, basically numbing the nerve. 23/71 people had undergone a nerve block for their severe headache at the Montefiore Headache Center. The NDPH-ICHD group responded to the nerve block much more often (88.9%) than the NDPH with migraine features (42.9% responded to nerve block).[5]

Opiates, or narcotics, tend to be avoided because of their side effects, including the development of medication overuse headaches and potential for dependency. NDPH is often associated with medication overuse.[4] To avoid the development of medication overuse headaches, it is advised not to use pain relievers for more than nine days a month.

NDPH, like other primary headaches, has been linked to comorbid psychiatric conditions, mainly mood and anxiety and panic disorders. The spectrum of anxiety disorders, particularly panic disorder, should be considered in NDPH patients presenting with psychiatric symptoms. Simultaneous treatment of both disorders may lead to good outcomes.[23]

Doxycycline has proven effective in a small study.[24] It is unknown if it mediates through anti-inflammatory or anti-bacterial properties of the drug, but the hypotheses is anti-inflammatory. Only 4 patients were in the trial, but 2 became 100% pain free, 1 had an 80% improvement in daily pain intensity, and the last person had a slight improvement in pain intensity and a more than 50% decrease in severe pain episodes. On average, patients improved after 3 months (2 daily dosages of Doxycycline, 100 mg).

Methylprednisolone

A five year retrospective, open-label, and uncontrolled study with a total of 63 patients who received intravenous therapy of methyl prednisolone and sodium valproate, showed an 86% response ranging from fair to excellent, with 67% representing good to excellent after a median follow-up of 9 months.[25]

  • 37% patients showed “excellent” response (no or less than 1 headache per month).
  • 30% patients had “good” response (>50 % reduction in headache frequency or days per month).
  • 19% patients had a "fair" response (< 50% reduction in headache frequency or days per month).
  • 14% patients had a "poor" response (minimal or no response).

Trigger site release

It has been theorized that trigger sites (TSs) exist where sensory nerves are being stimulated by a surrounding muscle or specific contact points. Due to this nerve irritation, a cascade of events is initiated, leading to the inflammation of the meningeal layers surrounding the brain, and to New Daily Persistent Headaches and Migraine Headaches.

Thus far, four trigger areas have been identified as surgical candidates. Three of these are in locations where the nerve passes through a muscle—where the greater occipital nerve pierces through the semispinalis capitis muscle, the zygomaticotemporal nerve through the temporalis muscle, and the supraorbital/supratrochlear nerves through the glabellar muscle group (the corrugator supercilii, depressor supercilii, and procerus muscles).[26][27][28] The fourth trigger point, however, has been identified in the nose of patients who have significant nasal septum deviation with enlargement of the turbinates.[27] The contact between these structures causes the irritation of the trigeminal nerve end branches and thus triggers headaches. Several large series of studies have been conducted to evaluate the efficacy of surgical obliteration of trigger points. Almost all demonstrated more than 90% response, with at least 50% improvement to complete resolution of pain symptoms.

This type of surgery is not offered as a first line of treatment, but after extensive evaluation and failure of traditional medical treatments.[27][29][30] Trials are still ongoing to standardize the procedures of choice for definitive management of NDPH and migraine headaches, but there have been successful guidelines for surgical therapy, which are being used by several migraine surgery specialists around the globe. [31]

Prognosis

Early history is a key to diagnosing NDPH. Evaluations to exclude secondary causes are necessary but usually negative.

Most patients have persistent headaches, although about 15% will remit, and 8% will have a relapsing-remitting type.[9] It is not infrequent for NDPH to be an intractable headache disorder that is unresponsive to standard headache therapies.

NDPH is difficult to treat and requires a multimodal approach. Questions regarding NDPH remain unanswered. Additional prospective studies are necessary to further understand, characterize, diagnose, and treat NDPH.

See also

References

  1. ^ a b c Li, D; Rozen, TD (2002). "The clinical characteristics of new daily persistent headache". Cephalalgia. 22 (1): 66–9. doi:10.1046/j.1468-2982.2002.00326.x. PMID 11993616.
  2. ^ Vanast, WJ (1986). "New daily persistent headaches: definition of a benign syndrome". Headache. 26: 317.
  3. ^ Silberstein, Stephen D.; Lipton, Richard B.; Solomon, Seymour; Mathew, Ninan T. (1994). "Classification of Daily and Near-Daily Headaches: Proposed Revisions to the IHS Criteria". Headache: the Journal of Head and Face Pain. 34 (1): 1–7. doi:10.1111/j.1526-4610.1994.hed3401001.x. PMID 8132434.
  4. ^ a b Grande, RB; Aaseth, K; Lundqvist, C; Russell, MB (2009). "Prevalence of new daily persistent headache in the general population. The Akershus study of chronic headache". Cephalalgia. 29 (11): 1149–55. doi:10.1111/j.1468-2982.2009.01842.x. PMID 19830882.
  5. ^ a b Karceski, S. C. (2010). "Daily headache: What have we learned?". Neurology. 74 (17): e73–5. doi:10.1212/WNL.0b013e3181dbe0c3. PMID 20421575.
  6. ^ a b Robbins, M. S.; Grosberg, B. M.; Napchan, U.; Crystal, S. C.; Lipton, R. B. (2010). "Clinical and prognostic subforms of new daily-persistent headache". Neurology. 74 (17): 1358–64. doi:10.1212/WNL.0b013e3181dad5de. PMC 3462554. PMID 20421580.
  7. ^ Goadsby, Peter J. (2011). "New Daily Persistent Headache: A Syndrome Not a Discrete Disorder". Headache: the Journal of Head and Face Pain. 51 (4): 650–3. doi:10.1111/j.1526-4610.2011.01872.x. PMID 21457252.
  8. ^ http://ihs-classification.org/en/02_klassifikation/02_teil1/04.08.00_other.html[full citation needed]
  9. ^ a b Evans, Randolph W. (2012). "New Daily Persistent Headache". Headache: the Journal of Head and Face Pain. 52: 40–4. doi:10.1111/j.1526-4610.2012.02135.x. PMID 22540206.
  10. ^ Young, William B. (2010). "New Daily Persistent Headache: Controversy in the Diagnostic Criteria". Current Pain and Headache Reports. 15 (1): 47–50. doi:10.1007/s11916-010-0160-4. PMID 21116742.
  11. ^ Monzillo, Paulo Hélio; Nemoto, Patrícia Homsi (2011). "Patients with sudden onset headache not meeting the criteria of the International Headache Society for new daily persistent headache. How to classify them?". Arquivos de Neuro-Psiquiatria. 69 (6): 928–31. doi:10.1590/S0004-282X2011000700016. PMID 22297882.
  12. ^ Rozen, TD; Roth, JM; Denenberg, N (2006). "Cervical spine joint hypermobility: A possible predisposing factor for new daily persistent headache". Cephalalgia. 26 (10): 1182–5. doi:10.1111/j.1468-2982.2006.01187.x. PMID 16961783.
  13. ^ Donnet, A.; Metellus, P.; Levrier, O.; Mekkaoui, C.; Fuentes, S.; Dufour, H.; Conrath, J.; Grisoli, F. (2008). "Endovascular treatment of idiopathic intracranial hypertension: Clinical and radiologic outcome of 10 consecutive patients". Neurology. 70 (8): 641–7. doi:10.1212/01.wnl.0000299894.30700.d2. PMID 18285539.
  14. ^ Vanast, W.J.; Diaz-Mitoma, F.; Tyrrell, D.L.J. (1987). "Hypothesis: Chronic Benign Daily Headache is an Immune Disorder with a Viral Trigger". Headache: the Journal of Head and Face Pain. 27 (3): 138–42. doi:10.1111/j.1526-4610.1987.hed2703138.x. PMID 3036747.
  15. ^ Diaz-Mitoma, Francisco; Vanast, Walterj.; Tyrrell, Davidl.J. (1987). "Increased Frequency of Epstein-Barr Virus Excretion in Patients with New Daily Persistent Headaches". The Lancet. 329 (8530): 411–5. doi:10.1016/S0140-6736(87)90119-X. PMID 2880216.
  16. ^ Meineri, P.; Torre, E.; Rota, E.; Grasso, E. (2004). "New daily persistent headache: Clinical and serological characteristics in a retrospective study". Neurological Sciences. 25: S281–2. doi:10.1007/s10072-004-0310-8. PMID 15549561.
  17. ^ Prakash, Sanjay; Patel, Niyati; Golwala, Purva; Patell, Rushad (2011). "Post-infectious headache: A reactive headache?". The Journal of Headache and Pain. 12 (4): 467–73. doi:10.1007/s10194-011-0346-0. PMC 3139051. PMID 21544648.
  18. ^ Rozen, Todd; Swidan, Sahar Z. (2007). "Elevation of CSF Tumor Necrosis Factor α Levels in New Daily Persistent Headache and Treatment Refractory Chronic Migraine". Headache: the Journal of Head and Face Pain. 47 (7): 1050–5. doi:10.1111/j.1526-4610.2006.00722.x. PMID 17635596.
  19. ^ Levy, Dan (2009). "Migraine pain, meningeal inflammation, and mast cells". Current Pain and Headache Reports. 13 (3): 237–40. doi:10.1007/s11916-009-0040-y. PMID 19457286.
  20. ^ Jacome, Daniel. "New Daily Persistent Headache As A Presenting Symptom Of Hashimoto's Encephalopathy". Webmed Central. Retrieved 22 December 2012.
  21. ^ Neufeld, Miriam Y.; Treves, Therese A.; Chistik, Vladimir; Korczyn, Amos D. (1999). "Postmeningitis Headache". Headache: the Journal of Head and Face Pain. 39 (2): 132. doi:10.1046/j.1526-4610.1999.3902132.x.
  22. ^ Tyagi, Alok (2012). "New daily persistent headache". Annals of Indian Academy of Neurology. 15 (5): 62–5. doi:10.4103/0972-2327.100011.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  23. ^ Peres, M. F.; Lucchetti, G.; Mercante, J. P.; Young, W. B. (2010). "New daily persistent headache and panic disorder". Cephalalgia. 31 (2): 250–3. doi:10.1177/0333102410383588. PMID 20851838.
  24. ^ http://headacheandmigrainenews.com/doxycycline-for-daily-headache/[full citation needed]
  25. ^ Prakash, Sanjay; Saini, Samir; Rana, Kaushikkumar Ramanlal; Mahato, Pinaki (2012). "Refining clinical features and therapeutic options of new daily persistent headache: A retrospective study of 63 patients in India". The Journal of Headache and Pain. 13 (6): 477–85. doi:10.1007/s10194-012-0461-6. PMC 3464463. PMID 22644215.
  26. ^ Attention: This template ({{cite pmid}}) is deprecated. To cite the publication identified by PMID 14758238, please use {{cite journal}} with |pmid=14758238 instead.
  27. ^ a b c Attention: This template ({{cite pmid}}) is deprecated. To cite the publication identified by PMID 15622223, please use {{cite journal}} with |pmid=15622223 instead.
  28. ^ Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi:10.1097/PRS.0b013e31817742da, please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi=10.1097/PRS.0b013e31817742da instead.
  29. ^ Attention: This template ({{cite pmid}}) is deprecated. To cite the publication identified by PMID 12045534, please use {{cite journal}} with |pmid=12045534 instead.
  30. ^ Attention: This template ({{cite pmid}}) is deprecated. To cite the publication identified by PMID 15622263, please use {{cite journal}} with |pmid=15622263 instead.
  31. ^ http://migrainesurgeryinstitute.com/ http://americanmigrainecenter.com/ http://www.migrainereliefatlast.com/ http://www.georgetownuniversityhospital.org/body_fw.cfm?id=8&action=detail&ref=3145

Further reading

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