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Transformed Migraine Is a Cause of Chronic Daily Headaches

Authors

  • Shizuko Konno MD,

    1. From the Cerebral Blood Flow Laboratory, Veterans Administration Medical Center, Houston, Tex. and the
    2. Department of Neurology, Baylor College of Medicine, Houston, Tex. (Drs. Konno, Meyer, Margishvili, and Haque) and the
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  • John Stirling Meyer MD,

    Corresponding author
    1. From the Cerebral Blood Flow Laboratory, Veterans Administration Medical Center, Houston, Tex. and the
    2. Department of Neurology, Baylor College of Medicine, Houston, Tex. (Drs. Konno, Meyer, Margishvili, and Haque) and the
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  • Gaiane M. Margishvili MD,

    1. From the Cerebral Blood Flow Laboratory, Veterans Administration Medical Center, Houston, Tex. and the
    2. Department of Neurology, Baylor College of Medicine, Houston, Tex. (Drs. Konno, Meyer, Margishvili, and Haque) and the
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  • Ronald A. Rauch MD,

    1. Radiology Service, Veterans Administration Medical Center, Houston, Tex. and the
    2. Department of Radiology, Baylor College of Medicine (Dr. Rauch), Houston, Tex.
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  • Md. Anwarul Haque MD

    1. From the Cerebral Blood Flow Laboratory, Veterans Administration Medical Center, Houston, Tex. and the
    2. Department of Neurology, Baylor College of Medicine, Houston, Tex. (Drs. Konno, Meyer, Margishvili, and Haque) and the
    Search for more papers by this author

Address all correspondence to Dr. John Stirling Meyer, Room 225 Building 110, 2002 Holcombe Boulevard-151A, Houston, TX 77030.

Abstract

Chronic daily headaches (CDH) consist of episodes of head pain occurring daily; more than 15 days each month; often associated with a history of migraine, with or without aura; or with a history of tension-type headaches occurring alone or both occurring together. Chronic daily headaches are frequently associated with rebound headaches after ergotamine, barbiturate, caffeine, and analgesic abuse. We previously reported that migraineurs with typical intermittent headaches exhibited excessive cerebral cortical vasodilation after oral acetazolamide which usually precipitated and reproduced their typical headaches. In the present study, cerebral vasodilator responses were tested by measuring changes in local cerebral blood flow (ΔLCBF) utilizing xenon-contrasted CT scanning, before and after oral administration of 14.3 mg/kg of acetazolamide, in 11 patients with CDH. The results were compared with 12 age-matched typical migraineurs, with and without aura, who had a history of migraine attacks occurring at intervals of 1 month or longer. Global and subcortical gray and white matter ΔLCBFs were quantitated and compared between both groups. After acetazolamide, ΔLCBF increased in cortical gray matter by 11.8% among patients with CDH and by 16.7% among migraineurs, with no significant differences between groups. Typical migraine attacks were provoked by acetazolamide in 9 patients (82%) with CDH and in 11 (92%) migraineurs with intermittent headaches. These observations are taken as evidence that at least 82% of patients with CDH have transformed migraine as judged by the provocation by acetazolamide of typical migraine attacks associated with excessive ΔLCBF increases. Serotonin agonists should be considered in the treatment of CDH to avoid ergotamine, caffeine, barbiturate, and analgesic abuse.

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