Etiopathophysiological assessment of cases with chronic daily headache: A functional magnetic resonance imaging included investigation
S. S., a 32-year-old married female, no children, with MSc educational level who had the complaint of ‘on and off’ mild to moderate headache for many years. Her more intense and frequent headache attacks started 5 years ago and had been a case of CDH (over 15 days per month headache) over the past 3 years. Her headache bouts were almost always very intense (rated 8-10/10 in VAS) especially when she was physically tired and was partially alleviated by sleep. She reported a unilateral (mainly right hemispheric) throbbing headache with no concurrent nausea, vomiting, photophobia and phonophobia during the episodes. Presence of headache did not follow a diurnal pattern. The patient neither had a significant past medical nor a family history of headache. The medication and substance use history was negative except for simple analgesics in routine basis. General and neurological physical examinations, laboratory workups and brain MRI were within normal limits. Her psychological assessments demonstrated normal cognitive functioning (MMSE and ACE); however, a minimal anxiety and depression was detected based on BAI and BDI-II scales, respectively. PSQI showed an appropriate sleep quality ().\nEEG and TCD studies upon maximal and headache-free episodes were unremarkable, showing no quantitative and qualitative differences in both states as compared to each other. The clinical impression for this case was again, chronic migraine headache.