Etiopathophysiological assessment of cases with chronic daily headache: A functional magnetic resonance imaging included investigation
A. J. was a 53-year-old female, widow, with no children, and illiterate. She revealed the history of quite often headaches responsive to analgesics since 5 years ago. After the loss of her husband (three years ago) she started to have chronic headache which affected her for more than 15 days per month. The headache was mainly bilateral and retro-orbital and if unilateral, was in right side involving occipital and upper cervical regions. The pain had a constrictive nature however not accompanied by nausea, vomiting, photophobia and phonophobia. The headache was aggravated during emotional stresses and alleviated by rest. In the past medical history, she had infertility. She used to take non-steroidal anti-inflammatory drugs (NSAIDs) for her chronic headache, which was not any more effective Moreover, the patient had not been administered prophylactic regimens for the headaches. Family history was not significant. Apart from the body mass index of 28, general physical examination was normal. Neurological examination, lab data and brain MRI were also within normal limits. Psychological evaluations (despite the illiteracy issue) showed a normal cognitive profile (MMSE and ACE). BAI and BDI-II scales showed a minimal anxiety and depression. Her sleep quality was impaired based on PSQI (). EEG and TCD evaluations in maximal and headache-free episodes’ were normal. Lab data were inconclusive. The clinical impression we had, was the chronic tension type headache.