Case Series: New Chronic Headache Subtype Uncovered

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The new headache was characterized by daily bilateral head pain which was most severe first thing in the morning or when in supine position.
The new headache was characterized by daily bilateral head pain which was most severe first thing in the morning or when in supine position.

A case series published in the Journal of Women's Health describes a new subtype of chronic daily headache that appears to be associated with elevated cerebrospinal fluid (CSF) pressure.

The 8 women included in this review were older (average age of onset: 57 years), were mostly overweight or obese (6 out of 8), had a history of episodic migraine (migraines were well-controlled or had ceased prior to new headache onset), and were either perimenopausal or in menopause.

The new headache was characterized by daily bilateral head pain which was most severe first thing in the morning or when in supine position. "Immediate worsening in Trendelenburg appears to be an almost diagnostic test for the syndrome and occurred in all patients," noted investigator Todd D. Rozen, MD, from the Mayo Clinic in Jacksonville, Florida. Neuroimaging was conducted but showed no abnormalities. 

With regards to treatment, all of the patients responded to CSF pressure-/volume-lowering therapies (ie, acetazolamide or spironolactone), however only one patient was able to taper off treatment completely without having headaches again.

"It is hypothesized that a combination of an elevated BMI and the presence of cerebral venous insufficiency leads to this form of daily headache," Dr Rozen concluded.

Reference

Rozen TD. A new subtype of chronic daily headache presenting in older women [published online September 25, 2017]. J Womens Health (Larchmt). doi:10.1089/jwh.2017.6460

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