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 .