Frequently Asked Questions
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Other Headache Types
(by MHNI Staff)
What is a rebound headache?
Analgesics (pain killers) are designed
to relieve pain, but if these drugs (both prescription and nonprescription) are
overused, they can actually cause headaches. This is known as analgesic rebound
headache (ARH) or "rebound headache." It may occur when overusing certain drugs
of the ergot family as well.
Headache sufferers taking analgesic
medications every day, or even as infrequently as two times a week, may find that
they must take ever-increasing dosages to achieve relief. With continued overuse
the medication becomes less and less effective, with pain-free periods between headaches
becoming shorter and shorter. The result can be a self-sustaining cycle of increasing
pain and medication.
Advertisements which promote "quick
cures" for headaches have added greatly to the frequency of rebound headache. Many
individuals with headache awaken each morning and retire each night with pain. Sufferers
have sought out various medical as well as non-medical avenues for help, ranging
from qualified health care to unqualified sources that offer simple explanations
and "miracle" therapies. Many individuals have turned to pain killers just to "get
through the day."
Typical signs of rebound headache
include return of an individual's headache 3-4 hours after the medication effects
wear off and headaches that occur daily or almost daily and last from six hours
to a full day. Sometimes rebound headaches occur every other day or even every third
day.
The best treatment for breaking
the rebound cycle is to discontinue excessive analgesic usage, which may intensify
pain at first but may lead to a dramatic improvement in pain following discontinuance.
Experience at MHNI has shown that some patients with rebound headache must be hospitalized
in our special head pain unit to provide an opportunity to carefully discontinue
the analgesic, treat the expected increase in headache, attend to the consequence
of overuse, and develop an appropriate treatment strategy. Long-term outcome is
usually excellent in straightforward cases of rebound.
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What is chronic paroxysmal hemicrania (CPH)?
Chronic paroxysmal hemicrania (CPH)
may be a variant form of cluster headache; it is
frequently confused with it and responds quickly to indomethacin (Indocin). CPH
was first described by Sjaastad and Dale in 1974. The condition occurs primarily
in women, and sometimes young girls, and the attacks, unlike cluster headaches,
may be precipitated by bending the neck and occasionally by rotation of the neck.
It rarely responds to medications that are effective for cluster headache. The originally
described pattern was characterized by multiple, short-lived, one-sided attacks
occurring daily and without remission. Subsequently, Kudrow et al. described an
episodic form in which headache phases were separated by prolonged pain-free remissions.
This form was referred to as episodic hemicrania (Kudrow, 1987). The pattern may
evolve from intermittent to continuous (chronic). Though rare, there are more than
100 cases of CPH in the literature. The chronic form seems to be more common than
the episodic form. Though initially thought to be more likely in younger people,
the mean age of reported cases is 33 years, with a range of 6-81 years (Newman,
1997). A family history of a similar condition is not found, although migraine may
occur in families.
Key clinical features
- Pain is one-sided and usually
localized to the eye, ear, temple, forehead, or lower jaw region.
- A range of pain forms (throbbing,
boring, stabbing, etc.) is possible, with moderate to severe intensity. Persisting
pain between acute attacks is reported.
- Attacks of pain last 2-25 minutes,
averaging 10-15 minutes (range 2-120 minutes). (Cluster headache attacks have a
mean duration of 45 minutes.)
- Patients generally prefer quiet
and rest; some patients pace, as in cluster headache.
- Attack frequency may be up to
40 per day but average 10-20 attacks per day.
- In the episodic form, the headache
phase is 2 days to 4.5 months. Remission is 1-30 months.
- Nighttime awakening occurs.
- Same side symptoms occur, similar
to those in cluster headache:
a. eye watering/nasal congestion
or discharge/eye congestion or redness;
b. forehead perspiration;
c. mild contraction of the pupils;
d. eyelid swelling;
e. light sensitivity;
f. nausea;
g. slow/fast heart rate; and
h. eyelid drooping.
- Headache can be provoked by
movement in 10% of cases; pressure on cervical region may precipitate an attack.
- Provocation by alcohol.
- Patients will frequently resort
to excessive aspirin or over-the-counter (OTC) ibuprofen to control pain, perhaps
due to the similarity in effect of indomethacin.
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What is hypnic headache?
Hypnic headache is a rare, distinctive
nocturnal headache disorder that affects elderly men and women (after age 60). The
attacks usually occur on both sides, but one-sided pain has been reported (Gould,
1997). The pain is throbbing in quality and occurs 2-4 hours after night-time sleep
onset, although attacks after daytime napping are reported (Dodick, 1998). It is
usually a short-lived attack with a duration ranging between 15 minutes to 3 hours.
Generally, there is an absence of associated autonomic features, although nausea
may be present. Hypnic headaches characteristically respond to lithium carbonate
(300-600 mg. at h.s.), although caffeine (Dodick, 1998) and indomethacin are also
reported to help (Ivanez, 1998). Both genders are affected; however, in Dodick's
recent large series, 84% of cases were women. It is generally considered a benign
disorder (Gould, 1997;Mosek,
1997; Newman, 1991; Raskin, 1997). At this time, a relationship to
cluster headache has not been established. However, the responsiveness to
lithium, the periodicity of the attacks, and their nocturnal relationship do raise
the question,
since these are also features of cluster headache. Raskin (1997) suggests
the possibility of disturbances of the "biological clock," which are serotoninergically
modulated. Lithium enhances serotoninergic neurotransmission.
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What is hemiplegic migraine?
A rare but frightening condition is the hemiplegic migraine
which is a typical migraine headache associated with complete or partial paralysis
on one side of the body. The paralysis
can last from hours to days in duration, followed by a full recovery of strength. An attack of hemiplegic migraine can
be triggered by minor head trauma such as that experienced in sports, or by other
typical migraine triggers. Hemiplegic
migraine attacks can occur in young children and may persist into adulthood. It may be a hereditary condition.
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What is basilar
migraine?
A basilar migraine is also an unusual migraine type but
it too can be associated with dramatic and frightening symptoms.
It occurs more frequently in teenage girls.
Some of the dramatic symptoms which are associated with basilar migraine include
complete or partial loss of vision, ringing in the ears, dizziness or spinning sensation
and loss of balance. Blackouts and confusion
can also occur. Children or adolescents may
be wrongly accused of being intoxicated because they may stagger or appear confused
during a basilar migraine episode.
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