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Semin Neurol 2022; 42(04): 512-522
DOI: 10.1055/s-0042-1757925
Review Article

Refractory Headaches

Olivia Begasse de Dhaem
1   Headache Specialist at Hartford HealthCare, Hartford, Connecticut
2   Department of Neurology at the University of Connecticut, Milford, Connecticut
,
Paul Rizzoli 
3   Department of Neurology, Brigham and Women's Faulkner Hospital J Graham Headache Center, Boston, Massachusetts
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Abstract

Medication overuse headache (MOH), new daily persistent headache (NDPH), and persistent refractory headache attributed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection represent a significant burden in terms of disability and quality of life, and a challenge in terms of definition, pathophysiology, and treatment. Regarding MOH, prevention without withdrawal is not inferior to prevention with withdrawal. Preventive medications like topiramate, onabotulinumtoxinA, and calcitonin gene-related peptide (CGRP) monoclonal antibodies improve chronic migraine with MOH regardless of withdrawal. The differential diagnosis of NDPH is broad and should be carefully examined. There are no guidelines for the treatment of NDPH, but options include a short course of steroids, nerve blocks, topiramate, nortriptyline, gabapentin, CGRP monoclonal antibodies, and onabotulinumtoxinA. The persistence of headache 3 months after SARS-CoV2 infection is a predictor of poor prognosis.

Keywords

new daily persistent headache - medication overuse headache - medication adaptation headache - chronic refractory headache attributed to SARS-CoV2 infection


Publication History

Article published online:
02 November 2022

© 2022. Thieme. All rights reserved.

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