Understanding Everyday Headache

Imagine that your 15-year-old daughter comes to you crying one morning because she has awakened with a very bad headache. She is very nauseated and can’t stand even the lights in the kitchen. Her whole head is hurting worse than any pain she has ever had. She has to stay in bed all day and miss school. Even worse, the headache is just as bad the next day, and then the day after that. Her pediatrician tells you that she is having headache from stress. Your otolaryngologist can’t find anything wrong with her. She still has the same headache every day and only gets through each day by sleeping through them. Eventually, she gets to see a neurologist who tells her that she has migraine, even though she has never had any headaches before and no one else in the family has headaches. He prescribes all sorts of medications used to treat migraine, such as Sumatriptan and Topiramate and Divalproex, but they only make her sicker.

This is the typical pattern of a severe headache that usually affects young women between 11 and 30 years old. It is called New Daily Persistent Headache and no one knows what causes it. This headache is NOT psychological, NOT caused by stress, NOT a migraine or any other kind of headache you or your neurologist has probably ever heard about. It comes out of a clear blue sky and 80% of the time it continues without any relief for many years. About 1/5 of the patients spontaneously improve within the first 2 years. Luckily, many of the patients only have moderate daily headache 24/7, but about half have the pattern seen above. All have abrupt onset of daily headache, continuous from the day of onset and refractory to almost all medications.

The best management for this terrible headache disorder starts with the understanding that it is an organic, bonafide illness that can produce severe disability. Second is to have the disorder properly diagnosed so that medical providers take it seriously and provide appropriate care. Medical imaging studies may rule in a secondary, structural cause for the headache such as cerebral venous thrombosis. Trials of different preventive medication may help up in up to 40% of those afflicted. Unfortunately, many patients continue to suffer so that we must look to the future for research which could tell us the cause and cure of this unremitting curse.

Herbert Markley, MD, FAHS, Director, New England Regional Headache Center, Inc., Worcester, MA.