New daily persistent headache.

New daily persistent headache was first described by Vanast in 1986 as a benign form of chronic daily headache that improved without therapy. In the headache specialist's office, new daily persistent headache is anything but benign and is thought to be one of the most treatment refractory of all headache conditions. Little is known about this syndrome.

Cluster headaches and sleep disorders.

Cluster headaches are characterized by unilateral paroxysmal attacks of severe pain with associated symptoms. The headaches occur during particular sleep stages and are associated with other chronobiologic factors. Several sleep disorders have been associated with the occurrence of cluster headache; multiple hormonal influences affect the relationship between sleep and headache.

Borderline personality disorder and the chronic headache patient: review and management recommendations.

Background: Physicians and psychologists who treat headache not infrequently encounter patients with borderline personality disorder (BPD). BPD patients frequently suffer from headache, and often pose special problems in treatment. Few guidelines exist for the management of the BPD headache patient.

Chronic headache: New advances in treatment strategies.

Chronic daily headache (CDH) affects approximately 4 to 5% of the population and encompasses a number of different diagnoses, including transformed migraine, chronic tension-type headache (TTH), new-onset daily persistent headache, and hemicrania continua. Although the pathophysiology of CDH is still poorly understood, some research has suggested that each of the various subtypes of CDH may have a different pathogenesis. The goals of prophylactic therapy are to reduce the frequency, severity, and duration of headache attacks; to improve responsiveness to treatment of acute attacks; to improve function; and to reduce disability.

Chronic daily headache prophylaxis with tizanidine: a double-blind, placebo-controlled, multicenter outcome study.

Objective: To assess the efficacy of tizanidine hydrochloride versus placebo as adjunctive prophylactic therapy for chronic daily headache (chronic migraine, migrainous headache, or tension-type headache).

Background: Tizanidine is an alpha2-adrenergic agonist that inhibits the release of norepinephrine at both the spinal cord and brain, with antinociceptive effects that are independent of the endogenous opioid system. Previous open-label studies have suggested the drug may be effective for treatment of chronic daily headache.

Behavioral and nonpharmacologic treatments of headache.

Cognitive-behavioral analysis and the multiaxial assessment of relevant behavioral domains (headache frequency and severity, analgesic and abortive use and misuse, behavioral and stress-related risk factors, comorbid psychiatric disorders, and degree of overall functional impairment) help set the stage for CBT of headache disorders. Controlled studies of CBTs for migraine, such as biofeedback and relaxation therapy, have a prophylactic efficacy of about 50%, roughly equivalent to propranolol. Cluster headache responds poorly to behavioral treatment.

Nefazodone for chronic daily headache prophylaxis: an open-label study.

Objective: To assess effectiveness, tolerability, and safety of nefazodone as a prophylactic agent for chronic daily headache.

Background: Nefazodone is a potent, selective 5-HT2 antagonist with a distinct and atypical mechanism of action. The evolution of intermittent migraine to chronic daily headache has been linked to up-regulation of 5-HT2 receptors as well as other factors.

An open-label dose-titration study of the efficacy and tolerability of tizanidine hydrochloride tablets in the prophylaxis of chronic daily headache.

Objective: To assess effectiveness and safety of tizanidine hydrochloride tablets for the prophylaxis of chronic daily headache.

Background: Tizanidine hydrochloride is an alpha2-adrenergic agonist that inhibits the release and effectiveness of norepinephrine at both central sites (eg, the locus ceruleus) and the spinal cord. It acts as a central muscle relaxant and has antinociceptive effects.

The use of rizatriptan in the treatment of acute, multiple migraine attacks.

Therapy for migraine can be classified as preventive or acute. Preventive therapy is intended to reduce the frequency of headache, whereas the goal of acute migraine therapy is to optimize the patient's ability to function by reversing, aborting, or reducing pain and migraine-associated symptoms. Rizatriptan is a new, selective 5-HT1B/1D receptor agonist that is effective for treatment of migraine.

Headache disorders.

Head, neck, and facial pain disorders possess characteristic features that, in some ways, distinguish them from other painful disorders. Generally speaking, the headache disorders can be reconciled within the same model of assessment as that of other painful conditions.

Headache level during neuropsychological testing and test performance in patients with chronic posttraumatic headache.

This study addresses (1) the relationship between headache presence/intensity at time of testing and neurocognitive performance, and (2) the probability that testing triggers or intensifies pain. Subjects were 125 patients with chronic posttraumatic headache (mean = 2.67 years post injury) who completed a 4-hour test battery emphasizing memory.

Diagnosis and symptomatic treatment of migraine.

Migraine is a common, complex neurophysiologic headache disorder. Most migraineurs have neither been diagnosed by physicians nor effectively treated. The clinical diagnosis of migraine is based on headache characteristics and associated symptoms, particularly nausea and vomiting.

Self-report of cognition and objective test performance in posttraumatic headache.

The Cognitive Difficulties Scale, a self-report measure of cognitive functioning, was administered to 111 consecutive adult referrals with posttraumatic head pain subsequent to mild to moderate head and/or cervical flexion-extension injuries who were treated at a clinic specializing in head pain and neurological disorders. Factor analysis of the Cognitive Difficulties Scale yielded seven meaningful factors corresponding to the types of memory inefficiencies often associated with neurological dysfunction. Further analyses comparing the Cognitive Difficulties Scale factor scores to objective tests of mental status, memory, and depressed mood demonstrated limited relationships between specific Cognitive Difficulties Scale factor scores and these measures of cognitive performance and behavior.

Double-blind trial of fluoxetine: chronic daily headache and migraine.

This study is the first double-blind placebo-controlled trial of fluoxetine for chronic daily headache (CDH) and migraine. After a one month single-blind baseline on placebo, subjects with CDH (n = 64) and migraine (n = 58) were randomly assigned to a three month trial of fluoxetine (20 mg) or an identical placebo. Fluoxetine and placebo were increased to 40 mg in the second month, depending on patient response.

Comprehensive inpatient treatment for intractable migraine: a prospective long-term outcome study.

This paper describes outcome data for 100 patients with severe, intractable, persistent migraine (chronic daily headache), who were admitted to a comprehensive inpatient Head-Pain Treatment Unit for a mean of 8.5 days. Headache, pain-related behavior, depression, sleep disturbance, functional performance, work status, and medication use were assessed at admission, post-discharge (mean = 2.

Daily chronic headache.

Headache is a disabling condition, and medical science has not, until recently, begun to address it in a fashion consistent with its widespread impact. Despite the limitations in our current understanding, as well as the historical prejudice directed toward patients with this condition, current understanding and treatment approaches can provide hope and relief for most patients who have these disorders.