Etiopathophysiological assessment of cases with chronic daily headache: A functional magnetic resonance imaging included investigation
P. K., a 52-year-old married female, mother of two children, with MA educational level had suffered from chronic headache since 20 years ago. For many years, the headaches were mild to moderate with long intervals. Following an emotional stressor, she started to experience regular and more intense headaches since 8 years ago and turned to a case of CDH since 3 years prior to the current presentation. She mainly complained of nocturnal headaches aggravated by intense emotions. Headaches were most often unilateral on the left side. Upon attacks, she became nauseated and sensitive to photic or acoustic stimuli. The headache was refractory to various analgesics. The patient's past medical history was not significant. There was a positive family history of intense headache in her mother and sister. She had no medication history except analgesics. Likewise, she had received no prophylactic regimen for the headaches.\nNeurological examinations and conventional MRI were normal. On psychological assessments, she had normal cognitive performance status (MMSE and ACE); however, BAI, BDI-II and PSQI scales showed that she had moderate anxiety and depression as well as poor global sleep quality. The psychological assessment results of all four cases are outlined in .\nOff-headache EEG demonstrated scattered sharp wave activity. The repeated EEG evaluation during the maximal headache episode, turned out to reveal generalized paroxysmal epileptiform activity. illustrates her EEG patterns during off-headache and maximal headache episodes.\nTCD findings in headache-free evaluation indicated a diminished mean blood flow velocity in bilateral middle and posterior cerebral arteries (MCA and PCA). However, it showed an increase in mean blood flow velocity in left MCA upon maximal intensity headache (the headache site, by 50%). Routine lab data was within normal limits. After all, the clinical impression was chronic migraine headache.