Chronic Daily Headaches: Clinical Profile in Indian Patients

Abstract

Chronic daily headache (CDH) remains a relatively unexplored entity in India. Misconceptions are common, unnecessary investigations often done and inappropriate therapy prescribed. Analgesic overuse is seldom recognized. The present report appears to be the first of its kind from India. CDH has been defined as headaches occurring more than 15 days per month for more than 3 months (secondary causes excluded). Over 2 years (1998-1999) 849 cases (49.6% of all primary headaches) were seen. More than 1 year's follow-up data were available in 205 subjects (M 34; F 171). The distribution of these was as follows: (i), chronic tension-type headache (CTH), 33 (16.1%); (ii), chronic/transformed migraine (TM), 169 (82.4%); (iii), new persistent CDH, 3 (1.5%). There were 169 cases of TM (M : F 1 : 4.7; age 26-58 years). History of past episodic migraine was present in all. Transformation had been gradual (89.4%) or acute (10.6%). Possible factors in transformation included psychological stress (44.4%), analgesic overuse (28.4%), ergot overuse (4.1%). HRT seemed to be implicated in three female subjects. Analgesic overuse was limited between intake of 600 and 2400 mg of aspirin equivalent per day (mean 735 mg). Ergot overuse varied between 1 and 3 mg/day of ergotamine for> or = 3 days/week. With medical therapy approximately 70% TM and 40% CTH patients noted significant improvement. About 80% of these relapsed on therapy withdrawal. CDH in India is not uncommon. Analgesic/ergot overuse needs to be recognized early. The average dose of analgesic implicated in CDH seems much less compared with that reported in the West.

Clinical profile of patients with chronic headache in a tertiary care hospital

“…Consistent with other studies, this study reflects the fact that headaches are more common in women. [11][12][13] In the present study, out of 100 patients with Chronic headache, primary headache was the predominant type accounting for 82% as compared to Secondary headache seen only in 18%.Consistent with our finding, AP Jain et al showed primary headache as the predominant type with a prevalence of 92.5% and remaining 7.5% with secondary headache.…”

Is chronic daily headache a useful diagnosis?

“…In a recent study from India [11], 849 patients with chronic daily headaches were reported, and 16% had CTTH, 1.5% had new daily persistent headache and 82% were reported to have transformed/chronic migraine. In the latter group, a large proportion had drug overuse and probably also coexisting tension-type headache, although only one headache diagnosis was applied to each individ- Table 1 Common subtypes of chronic daily headache in relation to the diagnostic criteria of the International Headache Society (IHS), second edition [7].…”

“…The last year prevalence is approximately 10%-12% for migraine, 35%-68% for episodic tension-type headache and 4%-5% for chronic daily headache, including 2%-3% with chronic tensiontype headache (CTTH) and 1.5%-3% with medication overuse headache (MOH), when the 1988 IHS criteria and the CDH definition by Silberstein et al [2] are applied [8][9][10][11][12]. However, in clinical studies from specialised headache clinics, the picture is completely different.…”

Tension-type headache: Why does this condition have to fight for its recognition?

“…In another older series of 630 CDH patients from Houston Migraine Clinic, 78% of patients had the socalled transformed migraine, with mixed features of migraine and TTH [17]. Furthermore, 73% of all patients used excessive amounts of symptomatic medication on a daily basis [12], and thus a clear diagnostic picture of the underlying primary headaches from such clinical series is difficult to delineate.…”

“…Unfortunately, most clinical and some epidemiologic publications do not report the coexisting TTH, only the migraines or the common denominator CDH [9,10,17].…”