COMPARATIVE ANALYSIS OF SURFACE ELECTROMYOGRAPHY DATA IN PATIENTS WITH CHRONIC DAILY HEADACHE AFTER BOTULOTOXIN INJECTION TYPE A AND STANDARD MEDICAL THERAPY

Goal. The aim of the study was to compare the results of surface electromyography after injection of Botulinum toxin type A and standard medical therapy. Material and methods. The study encompassed 62 participants with chronic daily headaches (CDH). Group I included 26 patients with chronic migraine (15 treated with BTX-A injection and 11 treated with standard medical therapy), whilst, Group II comprised of 36 patients with chronic tension type headache (20 treated with BTX-A injection and 16 treated with standard medical therapy) with an average age of 32.1 ± 10.3 (M ± SD) years. Before and after therapy, clinical questionnaires, instrumental data, and headache episode characteristics were collected from all patients. To examine the differences between BTX - A injection and standard medical therapy, we measured muscle activity with surface EMG in patients with chronic daily headache before and after 3 months of treatment. On days when the patients had no headache attacks, the surface EMG was measured. Results. After treatment, surface electromyography data revealed a statistically significant difference in outcomes between the patients who received BTX-A injection and those who received standard medical therapy. Before treatment on surface EMG, all patients with chronic daily headache had high amplitude and velocity in the muscles under study, and there was no statistically significant difference between these groups, where p => 0.05. In this study, it was discovered that there was no statistically significant difference in pericranial and neck muscles dysfunction (before treatment between patients receiving BTX-A injection and standard medical therapy in Group I, patients with CM 95% CI -0.9087 - 0.4887; t = -0.607, df = 40, p = 0.5470 and Group II, patients with CTTH 95 % CI -0.5756 - 0.4356, t = -0.27, After treatment, there was a statistically significant difference between groups treated by BTX- A injection and standard medical therapy, with CM 95% CI 0.3258 - 1.4142, t = 3.231, df = 40, p = 0.0025 and CTTH 95 % CI 0.1020 - 1.1780, t = 2.381, df = 58, p = 0.0206, where p = <0.05. Conclusion. The obtained results testify the effectiveness of BTX-A injections compared to standard medical therapy in patients with CDH.

Neuroimaging referral for reassurance in evaluation of headache with low-risk features

A clinical decision report using: Howard L, Wessely S, Leese M, et al. Are investigations anxiolytic or anxiogenic? A randomised controlled trial of neuroimaging to provide reassurance in chronic daily headache. J Neurol Neurosurg Psychiatry. 2005;76(11):1558-1564. https://doi.org/10.1136/jnnp.2004.057851 for a patient with daily headache.

CGRP antibody therapy in patients with drug resistant migraine and chronic daily headache: a real-world experience

Background Calcitonin gene-related peptide (CGRP) (receptor) antibodies (erenumab, fremanezumab and galcanezumab) are increasingly used in prophylactic treatment of migraine. In the approval studies, severely affected patients with migraine and chronic daily headache without any headache free days were excluded. Thus, less is known about the effectiveness of CGRP antibody treatment in this cohort. Methods Clinical routine data of 32 patients with migraine and daily headache were analysed after three months of treatment with a CGRP antibody (16 erenumab, 7 galcanezumab, 9 fremanezumab), including changes of monthly headache days (MHD) monthly migraine days (MMD) and monthly acute medication intake (AMD) as well as migraine characteristics. Statistical analysis was performed with the Wilcoxon-Test. Migraine characteristics were analysed descriptively. Results The number of MHD was significantly reduced (mean reduction (standard error), p-value): (-4.2 (1.3), p = 0.009) as well as MMD (-4.3 (1.6), p = 0.033). Four patients (13 %) reached a 50 % reduction regarding MHD and 8 patients (25 %) regarding MMD, migraine duration and intensity improved under therapy. Conclusions Despite the low responder rate, CGRP antibodies can be effective at least in a few cases of severely affected patients with drug resistant migraine and chronic daily headache. Trial registration Retrospective registered.

Transnasal Sphenopalatine Ganglion Block for the Preventive Treatment of Chronic Daily Headache in Adolescents

Chronic headaches are a major source of morbidity in the pediatric population, affecting physical function, school attendance, social capacity, mood, and sleep. In adults, repetitive sphenopalatine ganglion (SPG) blockade has been studied as a preventive treatment for chronic migraines. This case series aims to evaluate the SPG block for the preventive treatment of chronic daily headache (CDH) in adolescents. We prospectively evaluated 17 adolescents (14 females, 14 ± 1 year) with CDH not responding to cognitive behavioral therapy (CBT), physiotherapy, and standard medications. Each patient received 10 SPG blocks (two blocks/week) using the Tx360® device. At the end of treatment, 10 patients (59%) reported a Patient’s Global Impression of Change (PGIC) score ≥ 67%, and 3 months after the end of treatment, nine patients (53%) sustained a PGIC ≥ 67%. There was also a statistically significant reduction in the depression subscale of the Revised Children’s Anxiety and Depression Scale (RCADS) at the end of treatment and 3 months post-treatment compared with baseline. The procedure was well tolerated with no adverse effects. In our study, the use of repeat SPG blockade was associated with sustained benefits on the PGIC and the depression subscale of the RCADS when used as preventive headache treatment in adolescents with refractory CDH.

Relation of Hypertension With Migraine and Chronic Daily Headache in Population of Rafsanjan Cohort Study

Background: Headache has a variety of types, such as Migraine and chronic daily headache (CDH) in its primary form. There is a positive correlation between these two types of headaches and hypertension (HTN), but in some works this correlation has been reported negatively. Therefore, we planned to study HTN-Migraine as well as HTN-CDH correlation in our population.Methods: A sample of Rafsanjan population (10000 individuals) entered the cohort study, as a part of the prospective epidemiological research studies in IrAN (PERSIAN). In this population, we compared the frequency of HTN categories in cases with Migraine and CDH with a normal population (without Migraine).Results: Out of 9990 participants (46.6% males and 53.4% females) about 29% had Migraine and 7.5 % had CDH.HTN was found in 24.27% of Migraine and 31.98% of CDH cases. HTN was also found to be associated with Migraine and CDH in the crude model. Two Categories of HTN (Long controlled and uncontrolled) were not associated with Migraine. On the other hand, CDH showed associations with all the HTN categories. Moreover, in a model, which included all variables and confounders, Migraine and CDH had association with HTN without any considerable changes.Conclusion: Our study showed that there is strong HTN-Migraine as well as HTN-CDH correlations in the studied population.

Use of muscle relaxants and neurostimulation of treminal system in treatment of chronic daily headache

The article is devoted to the urgent problem of practical medicine – the treatment of primary cephalgia. The prevalence of chronic tension headache among the population of European countries is extremely high. Primary headaches are on the list of the most common causes of disability in all over the world. At the same time, existing treatment methods are often not able to completely cure this pain syndrome. In this work, the authors conducted a study on a new approach in the treatment of chronic daily headache: a combination of the non-pharmacological approach – stimulation of the trigeminal system using the Cefaly and the medication – the use of Kalmirex myorelaxant.In 61 patients with chronic daily headache, the effectiveness of the proposed approach was shown both in the relief of pain and in positive changes in the psychoemotional status and quality of life of patients.

Management of Chronic Daily Headache with Focus on Botulinum Toxin Type A

Aim: The purpose of the study was to review the efficacy, safety, and tolerability of botulinum toxin A (BTX-A) as a prophylactic treatment in adults with chronic daily headache (CDH). Material and methods: The research participated in 100 patients with CDH comparing two groups of patients. Group I, 54 patients (31 women and 23 men) treated by BTX-A and group II, 46 patients (27 women and 21 men) treated with the classical method, with an average age of 35 ± 9 years. The patient’s condition in group I was assessed on the third day, on the 7th day and the 15th day after the BTX-A injection and assessed every 15 days for 3 months, in group II the patients were evaluated every 15 days. Results: After 3 months headache severity in group I: 2 (3,7%) patients had no changes, 7 (12,9%) patients with less than 50 percent reduction in pain, 23 (42,6%) reported 70 to 95 percent pain relief, and 22 (40,8%) had complete relief. Group II: 12 (26,1%) patients had no changes, 16 (34,8%) patients with less than 50 percent reduction in pain, 10 (21,7%) reported 70 to 95 percent pain relief, and 8 (17,4%) had complete relief. The mean change from baseline frequency of headaches ranged from 3 ± 1 headaches per 30‐day periods in-group I and 7 ± 2 headaches in group II. The patient’s in-group I used painkillers for an acute headache 4 ± 1 day, compared to 10 ± 2 days for the group II per 30-day period. Conclusion: In this study, BTX-A injections are safe, well-tolerated, not any treatment-related serious adverse events reported. BTX-A injections recommended optimizing clinical outcomes for patients with CDH without using other prophylactic medications. Although, further observations are needed.

Integrative East–West Medicine Intervention for Chronic Daily Headache: A Case Report and Care Perspective

Chronic daily headache is a group of headache syndromes including most commonly chronic migraine and chronic tension-type headache, which often overlap, are complicated by medication overuse and are disabling, costly, and variable responsive to western pharmacotherapeutic interventions. There is growing research and awareness of integrative health approaches and therapies to address patients with chronic headache, yet limited examples of how to deliver this approach. This article reviews a commonly seen challenging case of a patient with overlapping chronic migraine and chronic tension-type headache complicated by medication overuse managed with an integrative east–west medicine intervention. This included person-centered biopsychosocial history taking, traditional Chinese medicine informed acupuncture, trigger point injections, and contributing factors modifications. A narrative review of the literature is presented to demonstrate an evidence-informed rationale for incorporating nonpharmacologic approaches to effectively help reduce the symptom burden of this patient population.