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She was putting in her contacts, and all of a sudden got a headache. He got a cold, and got a headache. She woke up with a headache.
Some of this may sound familiar. But when it comes to new daily persistent headache (NDPH), the headache starts but never stops.
NDPH is diagnosed when the headache is constant for at least 3 months.
There are a number of different chronic headaches. Many people have headache all the time, but don’t have NDPH. How is it different from or the same as other headache types?
NDPH starts suddenly, or over the course of a few days, but the start of it is remembered. Usually these patients don’t have a history of headache. But on a certain day, the headache starts, and it never stops. (If the patient can’t remember when the headache started, but the symptoms are similar to NDPH, it’s usually called chronic tension-type headache)
It’s usually a mild to moderate pressing or tight headache, not often pulsating.
The patient may have one of the following: sensitivity to light, sensitivity to sound, mild nausea. (If the nausea is severe or there’s vomiting, it’s diagnosed as a different type of chronic headache.)
The headache is usually (not always) on both sides of the head.
The headache is not made worse with physical activity.
NDPH strikes all ages, and both men and women, though it seems to strike more women than men.
Remember, there are many types of chronic headache. These are symptoms typical to NDPH.
Sometimes NDPH can go away, though it generally takes several months of treatment.
But very often NDPH is very resistant to treatment. Years go by, and patients do not find relief.
How do specialists try to treat NDPH? Very often treatments are similar to treatments for migraine. And sometimes those treatments work. But there is no typical treatment, and remember we’re searching for better treatments, because many patients have not yet found anything that works well.
Patients tell their stories…
Increasingly, patients with NDPH are telling and sharing their stories. If you want to read about the experiences of people with NDPH, here are some places to start:
When a headache never goes away by Deborah Kotz of the Boston Globe. This article from earlier this year explores the stories of patients and doctors trying to treat NDPH.
Living with NDPH, a blog from Amy, a mother and NDPH sufferer. Amy is also working on a book – hope we’ll see it soon!
If you’d like to learn more, you can listen to about an hour of questions and answers with Dr. George Nissan thanks to the National Headache Foundation. Listen here:
It’s been a while since we’ve talked about the NTI Tension Suppression System, or NTI-tss device for migraine treatment. The device now comes in a variety of forms to better suit individual patients, and is available in more countries than ever. A new agreement for distribution was signed in Germany, Switzerland, Austria and the Netherlands this fall.
The video below actually gives a really good overview of how the device works, and how your dentist will customize it just for you.
When you watch the video, notice how the action of the jaw hits key muscles and nerves in the face. This is where migraine attacks may be triggered in some people.
I think parents will appreciate a recent post from Dr. Alexander Mauskop regarding treatments for children. Here is a summary of his suggestions:
Try wafer medications (that melt under the tongue) or nasal sprays. Rizatriptan is approved in the USA for children, and Maxalt MLT is a “wafer” medication. Imirex NS (sumatriptan) is a nasal spray approved in Europe, and Zomig NS is another available in the USA.
Some common triptans used for children include rizatriptan (in the USA approved for children as young as 6), almotriptan, sumatriptan, and zolmitriptan.
Rizatriptan will be available in generic form around the end of 2012.
Child migraine attacks tend to pass quicker than adult attacks. This is another reason why faster acting medications are helpful (such as nasal sprays), but may also explain why some children tend to get over the attack quickly (in an hour or two) no matter what they take.
Triptans should not necessarily be the first choice for children with migraine. Other options include ibuprofen and paracetamol/acetaminophen, lifestyle changes (regular sleep/meals/exercise), biofeedback, magnesium, CoQ10, etc.
Another reminder or two – just because a triptan hasn’t been “approved” for children in your country does not mean that it won’t be effective. It just mean that the required studies haven’t been completed. However, always talk to your doctor before giving your child a triptan medication (or any medication, for that matter) for migraine!
Also, don’t be surprised if your doctor isn’t quick to recommend a pill. There are excellent, well proven non-drug treatments for children (some are mentioned above).
Aspirin is considered by many to be one of the better migraine treatments, both as an abortive and a preventative treatment. Should it be getting more attention?
Dr. Lidia T. Savi reported on an aspirin and migraine study at the European Headache and Migraine Trust International Congress. The study looked at a number of preventatives, and found that aspirin held its own.
Out of 194 patients with migraine with aura, 90 were given 300mg of aspirin (acetylsalicylic acid) each day. The rest were on a variety of other preventatives, such as propranolol (Inderal) and topiramate (Topamax). How did the patients do?
First question – how many saw a 50% improvement after 32 weeks?
Obviously, the aspirin group generally did much better than the rest. How about a 75% improvement after 32 weeks?
Once again, aspirin out did the others. As expected, there were few problems with aspirin, and no patients had to stop taking it over the 32 weeks due to side effects. Better yet, the patients on aspirin already saw improvement after 16 weeks (just over 3 and a half months).
This study does tell us that we need to seriously consider aspirin as a preventative treatment for migraine with aura. This study does not tell us that aspirin will be the most helpful for you.
This study actually raises a lot of questions. The methods can drastically change the outcome. For example, how were the patients diagnosed? Why were they put on the preventatives – was it random? There is no doubt whatsoever that some medications work better for some than others.
Even the lead researcher admitted that a larger study is needed.
It would be interesting to see more study in this area, especially for two reasons:
Migraine has been associated with increased risk of heart disease and stroke. Would aspirin help with treatment?
Some studies suggest that migraineurs have an increased risk of aspirin resistance. Why is that, and how would it affect treatment?
Meanwhile, this may be an option you’ll want to discuss with your doctor.
