Patients with sudden onset headache not meeting the criteria of the International Headache Society for new daily persistent headache. How to classify them?

Abstract

We conducted a retrospective analysis of the records of 1348 patients regularly treated at the headache clinic of Department of Neurology of Santa Casa de São Paulo, Brazil. Sixty-two patients reported history of daily and persistent headache. From the 62 patients selected, only 21 (group 1) could be diagnosed with new daily-persistent headache (NDPH) according to the International Headache Society (HIS) 2004 criteria. The 41 remaining patients (group 2) could not be diagnosed with NDPH according to IHS-2004 once they presented two or more migraine attack-related symptoms, such as: nausea, photophobia, phonophobia and vomiting, in different combinations. It was not possible to classify them in groups 1 to 4 of primary headaches either. How to classify them? We suggest that the criteria are revised. And one way we can classify them, would be the subdivision: NDPH with migraine features and without migraine features that would allow the inclusion of all individuals present who has a daily and persistent headache from the beginning Key words: chronic daily headache, headache, chronic tension-type headache, migraine, new daily-persistent headache, International Headache Society criteria.Pacientes com cefaleia persistente e diária desde o início que não preenchem os critérios da International Headache Society. Como classificá-los? RESUMO Realizamos uma análise retrospectiva do prontuário de 1348 pacientes acompanhados no ambulatório de Cefaleia do Departamento de Neurologia da Santa Casa de São Paulo, Brasil. Sessenta e dois pacientes relataram história de cefaleia persistente e diária (NDPH) desde o início. Destes, apenas 21 (grupo 1) puderam ser diagnosticados com NDPH de acordo com os critérios da Sociedade Internacional de Cefaleia 2004. Os 41 pacientes restantes (grupo 2) não puderam ser diagnosticados como NDPH, uma vez que apresentaram dois ou mais sintomas relacionados a cefaleia do tipo enxaqueca, tais como: náuseas, fotofobia, fonofobia e vômitos, em diferentes combinações. Não foi possível, também, classificá-los entre os grupos de 1 a 4 das cefaleias primárias. Como classificá-los? Sugerimos que os critérios sejam revistos. E uma maneira de podermos classificá-los seria a subdivisão da NDPH em: com características de enxaqueca e sem características de enxaqueca. Isso permitiria a inclusão de todos os indivíduos portadores de uma cefaleia diária e persistente desde o início Palavras-Chave: cefaleia crônica diária, cefaleia do tipo tensional crônica, enxaqueca, cefaleia persistente e diária desde o início, critérios Sociedade Internacional de Cefaleia.

Refining clinical features and therapeutic options of new daily persistent headache: a retrospective study of 63 patients in India

“…Twenty-two patients (35 %) had prominent migrainous features (NDPH-mf). In similar observation in other larger cohorts, 34–44 % patients had fulfilled the criteria for NDPH-ICHD [2, 3, 9]. Epidemiological and clinical features of these two groups were substantially similar, except the presence of migrainous features in NDPH-mf, which were the differentiating features between two.…”

“…However, these all case series had patients with prominent migrainous features. Even after the development of ICHD criteria for NDPH, most authors bypassed it and used broader set of criteria which includes migrainous features [2, 3, 6, 8, 9, 11]. In this retrospective study, we examined the patients fulfilling the Kung et al’s criteria for NDPH, which allows to include migrainous features.…”

“…Unilateral head pain, throbbing headache, severe intensity, exacerbations by physical activities, moderate to severe nausea, and vomiting are not the features of NDPH. However, most studies suggest that migrainous features may be the part of the clinical spectrum of NDPH or a clinical sub form of NDPH exists [6–9]. Initially, NDPH was considered as a “benign or self-limiting” form of headache.…”

New Daily Persistent Headache: Historical Review and an Interview with Dr. Walter Vanast

“…In recent years, NDPH has been described in many populations internationally, continuing to demonstrate the common presence of migraine features . Clues to the underlying pathophysiology remain elusive, as there appears to be no clear neuroradiological signature or singular trigger, though an antecedent infectious prodrome is reported by a sizeable minority of patients in many series .…”

“…1 In recent years, NDPH has been described in many populations internationally, continuing to demonstrate the common presence of migraine features. [9][10][11][12] Clues to the underlying pathophysiology remain elusive, as there appears to be no clear neuroradiological signature 8,13 or singular trigger, though an antecedent infectious prodrome is reported by a sizeable minority of patients in many series. 5,8,12,14 Though such retrospective trigger reporting may be subject to recall bias, 15 it continues to raise the possibility proposed by Dr. Vanast and coworkers decades ago that NDPH in some patients may be a secondary headache related to an immunological response triggered by latent Epstein-Barr virus reactivation 16,17 or other microbial pathogens.…”