issue. I have also seen an ear, nose and throat specialist

; eye doctor; and acupuncturist but have not

found any answers or relief. I’ ve had an MRI and

CT scan and both appear normal. I’ ve also been

tested for Lyme disease( negative). Obviously, I’ m

extremely frustrated and fearful that I am going to

be living with this forever. Do you have any advice

on where to go next? Have you heard of anything

like this?

– Hilary M.

Although we certainly do not have great detail on your headache, it is most likely that you suffer from either chronic tension-type headache or new daily persistent headache( NDPH). Both conditions are characterized by global or bilateral dull, pressing, tightening pain that is mild to moderate in intensity. Both are otherwise relatively featureless, without nausea, vomiting, visual or sensory changes, or significant sensitivities to light or noise. Both are poorly responsive to preventive

medication, with NDPH failing all medical options. The difference often lies in the onset: Chronic tensiontype headache typically develops in individuals who possessed a prior history of at least some tension-type headaches, with evolution into a daily pattern occurring over months or even years; NDPH arises abruptly in those without prior headache history and plateaus within 72 hours into a 24 / 7 phenomenon. Headache specialists are indeed your most appropriate avenue for care with either of these conditions.

– Robert G. Kaniecki, MD, University of Pittsburgh

BOTOX BUSTER

I have suffered from chronic paroxysmal hemicranias

( CPH) for six years. Although I do get relief

from indomethacin, I am wondering if there are

any other treatment options that have shown

success in CPH patients. My doctor suggested

calcium channel blockers, but because they cause

constipation and low blood pressure, it is not an

option for me.

I saw the recent letter about daily headaches in the

Sept. 16 NHF News to Know member e-newsletter.

Botox was a suggestion. Could this work for CPH?

– Cindy W.

Botox has been shown to be effective in patients with one subset of chronic daily headache, specifically chronic migraine. Another subset of chronic daily headache, chronic tension-type headache, has not shown any benefit from Botox administration. There is no significant data for Botox in CPH, and we have no clinical experience with its use in this condition either. Indomethacin responsiveness is a hallmark of CPH, and in fact is required to arrive at that diagnosis. It has been my experience that indomethacin works dramatically for this disorder while other medical treatments are almost always ineffective.

– Robert G. Kaniecki, MD, University of Pittsburgh

Hormone Helper I’ m a long-time subscriber to NHF newsletters and I’ ve just received Head Wise. I was so excited to read two of your lead articles:“ The Perfect Complement” and“ Ahead of the Curve.” I have been a migraine sufferer for over 37 years, worked with a headache specialist for over 20 and now I’ m in menopause, which was always dangled as a carrot in front of me— the promise that menopause would bring migraines to an end. Well, they just got worse.

In 2009, I was miserable, having 16 migraines a month and being on and off steroids. A friend told me about a seminar she attended by a local doctor who had left years of traditional medicine behind to study holistic medicine. I made an appointment and had my first consultation. As we talked, I told him that the only time I had been headache free was when I was pregnant and nursing my three children. He said that this could be a key. Hormones, like progesterone, go way up during pregnancy and nursing; as you wean, they start to go down to a new normal. As you stated in your article, a woman’ s hormones fluctuate constantly during the month.

I had lab work done and it proved the doctor’ s theory: My hormone levels were in the basement, so low. He prescribed natural, bioidentical hormone therapy and within one month I saw dramatic improvement. I have continued this therapy for 18 months now and am so excited to report that I’ m averaging about four migraines per month and those I’ ve noted were triggered by weather changes( barometric actually, which is hard because I live in Cleveland, Ohio). I want to help others with migraines. I know the pain and I’ ve lived only half my life because of migraines.

If you have comments or suggestions about Head Wise, send them to info @ headaches. org or post them on the NHF Facebook page.

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– PAT H.