Today’s post is a summary of another fascinating interview from the World Migraine Summit, this time with Dr Andrew Hershey, a director of neurology at University of Cincinnati. This presentation on ‘new daily persistent headaches’ revealed (again) that headaches and migraines are complex critters (my word not theirs). There were so many different types of headaches that were discussed, many that appear to overlap (at least to me) that it became a little difficult to determine where one diagnosis might end, and another begin.
[Disclaimer – a quick reminder that I have NO medical training – this post represents my best understanding of a complicated subject – please be sure to talk to your doctor if you need medical advice.]
A daily persistent headache often appears in someone who has never had headaches regularly before, it generally appears all of a sudden, and stays present for 24 hours a day, for several days, months or years.
Where I got a little confused is there is also a diagnosis called ‘continuous headache’ for which the above seems to be a subset. And there were some distinctions between this type of headache and migraines. This is definitely one of those instances where it would be very difficult to self-diagnose yourself, and individual medical advice is required. Dr Hershey even noted, later in the interview, that until we can see specific biomarkers (biological indicators) then we can’t really separate the subsets neatly.
Dr Hershey spoke briefly about those who have episodic migraine, then undergo a process of ‘chronofication’ in which they slowly transition to chronic migraine.
[For myself, it was around my birthday in June 2022 that I became aware of the fact that my right eye and eyebrow were sore, and I realized it had been there for a couple of days. Normally, the pain was a signal that I was about to have a migraine attack, but I suddenly realized that the pain had been ‘hovering’ without ‘escalating’. Since then, the pain has never really gone away, and the dull ache has lasted two and a half years non-stop. Separate to that, however, I then began to get more and more regular migraines until they were diagnosed as chronic nearly two years ago.]
It was interesting to hear that many patients can remember the exact day that their continuous headaches begun, usually because there was an associated ‘anchoring event’. Once you’ve drawn attention to that anchoring event it continues to be a memory onto which additional memories can be added. [This could be a bump on the head, or as for me, a memory of my birthday realization that my eye was sore but surprisingly not escalating to migraine. I definitely use this as a milestone date for calculating how long the pain has been going – for better or worse.]
In terms of triggers for persistent daily headaches, they seemed to be three primary causes; viral (Covid or other illnesses); a result of a post traumatic head injury; and possibly as a result of ongoing anxiety and depression. [Which I would hesitantly interpret as chemical/biological, physical or psychological.]
Dr Hershey and the interviewer discussed the fact that many new cases tended to arrive in Spring and Autumn (Fall), and that migraines are often more prevalent at this time, due to: storms which create significant pressure changes; an increases in allergens associated with hay fever etc, which might not cause headaches but can be a ‘background stressor’ on the body; an increase in respiratory illnesses that go around at this time; and possibly an increase in new season sports (new players – new bumps).
He spoke of the ‘loop’ or ‘cycle’ which these patients, and people with migraine, get stuck in, in which we feel pain > become anxious about that pain and worry about getting better > don’t get better so become fatalistic we’ll never get better > which creates a greater sense of pain and anxiety > increased fatalism… and so on.
[I wrote a separate post about this ‘downward spiral’ of a pain pathway HERE.]
He said the treatments for these sorts of headaches are essentially the same as for migraine – take care of your body and you’ll take care of your brain.
Dr Hershey mentioned 6 specific remedies in this order; (1) hydration, (2) exercise, (3) eating regularly and healthily, (4) getting regular adequate sleep, (5) cognitive behavior therapy to help you learn to cope better with pain, and lastly, (6) medication (preventative and acute) with the caveat that this type of headache in particular is susceptible to medication overuse.
There was a brief discussion about how some patients get better, then return to having headaches. Dr Hershey spoke of a preferred focus on getting better to a ‘goal’ rather than simply “getting better”. The aim, for example, is to eliminate 50% of your headaches rather than 100%. [And then I guess you could later go for 50% again… and again…]
He reminded everyone that his job is to educate patients rather than treat them – to a large extent it’s up to them to make the lifestyle changes that will help them heal.
The good news is that this type of headache will get better, but like other chronic headaches, it will take time. The earlier you realize there is a problem and get a diagnosis, the sooner you’ll start a treatment program, so the sooner you’re likely to heal.
Dr Hershey reiterated there is not really a point at which you have ‘tried everything’ – if you feel that way, then look to change your healthcare team, get a second opinion, or volunteer for clinical trials – keep trying – don’t give up.
He ended by reassuring everyone that education is key, and as such, by learning about headaches you’re already on the right track.
Here, here… since you’re here!
Take care, Linda x
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PS – if you want more information, here’s some links I found:
New Daily Persistent Headache (NDPH): Symptoms & Treatment (clevelandclinic.org)
The Mindful Migraine 
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