Chronic migraine occurs in people with more than fifteen headache days per month over a three month period of which more than eight are migrainous and for whom medication overuse headache has been ruled out as a potential cause.
Chronic migraine is treated with many of the acute medications used for episodic migraine but most chronic migraine sufferers will need to access a migraine preventative to improve their long term outcomes.
**If you are suffering from chronic migraine or daily persistent headache you should seek a referral to a migraine specialist or to one of the migraine clinics throughout Ireland.
Despite the availability of highly effective abortive and prophylactic therapies for migraines, a significant minority of migraine sufferers do not respond to these treatments.
This condition is known as refractory chronic migraine and affects a relatively small but significant proportion of chronic migraine patients. New medications such as CGRPs and new research into stem cell treatment for refractory chronic migraine may offer hope to those suffering from the condition.
New daily persistent headache can occur at any age from childhood through to your 70’s. It usually begins one day and despite lifestyle and dietary adaptations and medical intervention, sufferers can not seem to stop this headache occurring.
Sometimes the person has suffered a cold or viral infection or there has been a particularly stressful event in their lives. Some people also report the onset of NDP after they underwent a surgical procedure . But equally there can be no obvious trigger or triggering event.
Many NDP sufferers can also suffer from migraine like symptoms and others experience tension type headaches. You must experience daily headaches continuously for at least 3 months before you can be diagnosed with New Daily Persistent Headache
Diagnosing Persistent Headache
Medication Overuse Headache must be ruled out at first so your medic will assess the amount of medication consumed on a weekly and monthly basis.
Then the overall health of the individual should be assessed and potential underlying causes eliminated.
The list of possible tests that may be carried out are as follows
- Blood testing – to discount anemia or an increase or decrease in white blood cells or platelets, They may also test that kidneys and liver are functioning as they should.
- CAT Scan or MRI are often ordered as a precaution to make sure nothing has been missed.
- Lumbar Puncture : This is when a measure of spinal fluid pressure may be performed by placing a small needle in the back.
- Neck Examination: The neck may be examined to make sure there is no compression of the nerves resulting in an ongoing headache. The blood vessels that supply the brain may also be checked to make sure there is no interruption in flow.
- In individuals older than 50, a blood erythrocyte rate (ESR) is drawn, and there may be a biopsy of the arteries at the temples if the ESR is elevated.
In many cases NDP headache may disappear with an improvement in overall diet and lifestyle. Most patients will need to try at least 3 preventatives before being referred for other treatment options such as nerve blocks and Botox.
Botox and nerve blocks have varying levels of successes. A DHE infusion may also be suggested to abort the headache. This infusion must be administered intravenously and requires hospital admission. Some of the preventatives that your neurologist may prescribe are pressure medications such as propranolol or candesartan, antidepressants that target pain receptors such as amitriptyline, nortriptyline, or venlafaxine, or antiseizure medications such as topiramate.
Physiotherapy, Biofeedback, behavioural treatment, and relaxation therapy may also be of benefit. Acupuncture may offer you some relief from the daily onslaught of NDP headache.