Clinical Characteristics And Drug Intervention Of Chronic Daily Headache In The Neurological Headache Clinic

Objective: The aim of this study was to investigate the clinicalcharacteristics of chronic daily headache in a neurological headache clinic，and provide evidence for the prophylaxis, diagnosis and treatment ofchronic daily headache in clinical practice.Methods: The study was conducted in the neurological headache clinicof the First Affiliated Hospital of Chongqing Medical University betweenNovember2009and February2012. A self-administered questionnaire wasused to collect headache history. Physical examination was carried out by theneurology expert for each headache patient. Headache diagnosis was basedon the criteria of the second edition and the revision of the InternationalClassification of Headache Disorders (ICHD-2). Statistics analysis was usedto analyze the clinical characteristics of chronic daily headache patients.Results: The prevalence of chronic daily headache was31.9%amongheadache patients in the neurological headache clinic, the majority (79.5%) of patients with chronic daily headache were female with an average age of45.34±11.39years and many patients only had primary education.Medication overuse headache （41.4%） and chronic tension-typeheadache(40.5%) were the two most common headache types. The averageage of headache onset was27.83±12.15years, the average course of diseasewas16.20±12.29years and the mean headache frequency was24.52±6.84days in the previous three months. Chronic migraine patients suffered fromlonger headache history and more severe headache intensity than chronictension-type headache patients (P<0.005). Most patients with medicationoveruse headache had migraine as their primary headache and overusedcombination analgesics (85.4%). About half of chronic daily headachepatients had MIDAS Grade3or4and MIDAS scores were significantlyhigher in chronic migraine patients than chronic tension-type headachepatients (P<0.005). Of all chronic daily headache sufferers,45.9%hadanxiety and24.1%had depression, most of them had poor sleep quality(70.2%). More than half of patients with chronic daily headache hadconsulted a physician for headache in the previous year (60.4%), however,only three patients had used preventative medications,47.9%of patients hadnot received any diagnosis from their physicians and22.9%reported aphysician diagnosis of primary headache.Conclusion: About one third of headache patients suffered from chronicdaily headache in our headache clinic. Medication overuse headache and chronic tension-type headache were the two most common headaches.Chronic migraine patients suffered from longer headache history and moresevere headache intensity than chronic tension-type headache patients.Medication overuse was common in chronic daily headache sufferers and themost frequently overused medication was combination analgesic (headachepowder). In addition to the significant impact on the quality of life of thesufferers, chronic daily headache causes a socioeconomic burden due to theabsenteeism or reduced effectiveness from work. Anxiety, depression andsleep disturbance were common in chronic daily headache patients. Mostchronic daily headache patients had consulted a physician for headache inthe previous one year, but it remains underdiagnosed and undertreated inclinical performance. Our findings indicate the urgent need to increaseawareness and improve diagnosis and treatment of chronic daily headachein clinical practice. Objective: To evaluate the therapeutic effect and safety of Duliangsoft capsule, and compared with amitriptyline in treating patients of chronicdaily headache.Methods: Of75chronic daily headache patients in our study,39weretreated with Duliang soft capsule and36with amitriptyline for4weeks.Each group was evaluated by headache severity, frequency, duration, andadverse reaction before and after treatment. Blood tests andelectrocardiogram were conducted for patients treated with Duliang softcapsule before and after treatment.Results: The headache severity, frequency and duration of Duliangsoft capsule group were significantly improved after treatment (P＜0.05).The total effective rate of headache severity, frequency and duration weresimilar between the two groups (P＞0.05). No serious adverse drug reactionwas found and the safety index before and after treatment were notsignificantly abnormal in Duliang soft capsule group.Conclusion: Duliang soft capsule can improve the headache severity,frequency and duration in patients with chronic daily headache, and it was safe for treatment. Its short-term curative effect was similar toamitriptyline.