Etiopathophysiological assessment of cases with chronic daily headache: A functional magnetic resonance imaging included investigation
M. K. was a 54-year-old male, married, father of two children and with educational level of PhD. He reported mild transient headache since young adulthood, becoming a known case of migraine when he was 26 years old. He used to take ergotamine–C upon headache during those years. Due to severity and frequency of episodes, he was given prophylactic regimens since the age of 40; however, became refractory in a matter of few years. He was labeled as CDH since 5 years ago. The headache had been intrusive in over 20 days per month lasting 15 hours per day in average. Headaches are mostly bilateral, causing photophobia and phonophobia and accompanied by nausea and vomiting in severe instances. The headache timing did not follow a distinct pattern; however, was more intense at nights. Pain was partly alleviated by sleep. His past medical history was negative. He revealed a family history of migraine in her mother. Over the past few years, he experienced various medications including prophylactic tetracyclic antidepressant, benzodiazepines, antiepileptic, beta blockers and lithium carbonate to all which he failed response. He had recently been taking sumatriptan and ergotamine as abortive medication upon headache episodes, with a very modest response. His general and neurologic examinations as well as the conventional brain MRI with and without contrast were normal. His psychological assessments indicated a normal neuro-cognitive state (MMSE and ACE); however, with a minimal anxiety and depression based on BAI and BDI-II. His sleep quality was evaluated poor, as per PSQI ().\nHe had no significant findings during maximal and minimal headache EEG and TCD evaluations. After all assessments, our impression was medication overuse headache (MOH). His acute phase medications were discontinued and interestingly, after many years, his headache turned into less intense with an episodic pattern, once or twice a week.