Day 3
Lawrence Newman: Daily, unresponsive refractory headache
Types of chronic headache
1. Chronic
tension
2. Chronic
migraine
3. New
daily persistent headache
4. 15+
headache days a month
MOH (medication overuse headache) – adding fuel to the fire. Short term
gain- long term making headaches and situation worse.
Misdiagnosis sometimes between chronic migraine and new daily persistent
headache.
Primary headache disorder – headache itself is the problem
Secondary headache disorder- MOH, stroke, brain tumour etc
Important in diagnosis (frequency, location of headache and what does it
actually feel like)
51 million people have daily refractory headache!
New daily persistent headache
1. Migraine
and tension headache features
2. Different
from type of headache they have ever experienced before
3. No
headache history and within 3 days onset
4. Often
comes on following; a virus, head trauma, stress or a surgical procedure
Treatment options?
1. Anti-migraine
drugs and tension headache drugs
2. If
it was after an infection – anti viral, anti-inflammatory and anti-asthma drugs
3. Double
jointed people (injections can interrupt the pain)
4. Neuromodulation
devices- both invasive and non-invasive can be used
Inpatient stay can sometimes be useful to help ramp down the cycle of
pain. Nerve blocks are often administered along with stress management and
biofeedback.
Chronic pain & depression sadly go hand in hand.
New daily persistent headache tends to be more medically resistant at
the moment BUT
“There is hope and NO reason to give up!”
Important lifestyle factors
*SEEDS*
1. Sleep:
8 hours a night
2. Eating:
Don’t skip meals
3. Exercise:
3 days a week for 30 mins
4. Drinking:
5 glasses of water +
5. Stress
reduction: exercise (can tick of two at the same time)
Day 3
Andrew Charles: 6 medications that can make migraine worse.
Andrew is part of the Goldberg migraine programme. Talks about
non-migraine drugs that many of us take causing problems.
Not evidence based (needs more research), largely observation from in
the clinic.
1. SSRI
– Anti-depressants (Prozac)
- Observation
in clinical practice
- Exacerbating
migraine
- SNRI
could be a good alternative to use instead
- Depression
and migraine (comorbidity) mood issues associated with people with migraine
2. PPI
– Proton pump inhibitors (gastro acid reflux)
- Taiwan
study (start on a PPI and saw an increase in headaches)
- What
is your biggest problem? Is the benefit of this medication worth the possible
exacerbation of your migraines?
- Look
for alternative if you really think you need to be on something for this.
- Possible
rebound reaction when you first stop taking this drug
3. Nasal
steroids/decongestants
- Claritin
D & Pseudoephedrine
- Look
for something without a decongestant in them
- Long
term use of these steroids – exacerbates migraine
- Good
alternatives – anti histamines
4. Oral
contraceptives
- Hypothalamus
drives hormonal system (every hour hormone released in the brain)
- Oestrogen
falls – migraine attack
- Having
more oestrogen doesn’t seem to be good for migraine either
- Low
dose continuous can be helpful or coming off it completely
5. Hormone
replacement therapy
- Oestrogen
patches
- Long
term- not good for migraine
6. Pain
medication
- Not
frequent use
- MOH
- Pain
meds making migraine worse
-
- Need
to be very careful with opioids- codeine
- Caffeine
containing analgesics can be worse for those with migraine for example,
Excedrin
- Important
to communicate to neuro what you are taking
Coordinating pain from different doctors – patient has the ability to
educate their physician and increase awareness for primary care doctors and
with OBGYN for example.
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