Therapeutic Effect of the Patients with Chronic Migraine in Pain Clinic

Yoon, Jae Won; Moon, Dong Eon; Yang, So Young; Park, Chong Min

Abstract

BACKGROUND
Chronic daily headache (CDH) is surprisingly common and is defined by headaches that occur for > or = 4 hours a day on > or = 15 days a month over a 3 month period. Indeed, CDH is a group of headache disorders that includes chronic migraine (CM). Despite the personal and societal impact of this disorder, CM continues to be misdiagnosed and under-treated even though there are well-established diagnostic criteria as well as safe and effective treatments. The inappropriate use of medication for treating the headache episodes might contribute to the development of CDH, which is refractory to medical and non-medical treatments. A nerve block has been used to treat diverse headaches for a long time even though there is some controversy regarding its effectiveness. A study on the clinical characteristics of CM was performed. Here we report the therapeutic results of conservative treatment modalities as well as nerve block in a pain clinic. METHODS: Prospective study and research on the clinical characteristics of CM was performed. The Silberstein and Lipton criteria (S-L criteria) were used to classify CDH, and the effectiveness of treatment including drug therapy and nerve block was evaluated after 3 months. RESULTS: Most of the CDH were CM with a female predominance. Several psychopathological factors (e.g. psychiatric comorbidity, personality traits) were frequent in the CM patients. The overuse of medication (abortive drugs for migraine) might favor chronicity. After treatment for 3 months, significant improvement in the visual analogue scale for pain and the patient's satisfaction were obtained in most cases. CONCLUSIONS: CDH usually occurs in the form of an episodic headache, which was migraine in most cases. In addition to conventional treatment, a neural blockade appears to be effective in treating CM and medication overuse headache (MOH), but controlled studies will be needed to confirm these preliminary findings.