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Chronic headache: new advances in treatment strategies.
Author(s) -
Lake AE,
Saper JR
Publication year - 2003
Publication title -
headache: the journal of head and face pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.14
H-Index - 119
eISSN - 1526-4610
pISSN - 0017-8748
DOI - 10.1046/j.1526-4610.2003.03085_14.x
Subject(s) - medicine , migraine , neurology , chronic migraine , pathophysiology , population , intensive care medicine , cluster headache , bioinformatics , anesthesia , psychiatry , environmental health , biology
Neurology. 2002;59(5 suppl 2):S8‐S13. 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. However, opinions differ as to exactly which are the best and most appropriate outcome measures for prophylaxis. Several pharmacologic treatment options exist, including antidepressants, anticonvulsants, muscle relaxants, serotonin agonists, ergots, serotonin antagonists, antianxiety agents, and other miscellaneous drugs. Tizanidine, an alpha(2)‐adrenergic agonist, has recently emerged as a promising prophylactic adjunct for CDH, which implicates a central alpha(2)‐adrenergic mechanism as an important factor in the pathophysiology of CDH. Comment: Drs. Lake and Saper provide a superb overview of frequent headache, and taken with Dr. Silberstein's article described above, the two reviews constitute the most up‐to‐date reviews on the subject. SJT