A new subtype of chronic daily headache presenting in older women

In early menopausal age, the frequency of headache in women's is usually changed during the whole period. Most had a history of migraine, but their migraines had typically been under good control or even stopped when they presented with a new headache syndrome. In this research, Rozen et al defined a new subtype of chronic daily headache appeared to be caused by a state of elevated cerebrospinal fluid (CSF) pressure.

To define a new subtype of chronic daily headache among females with a particular age group.

This is the case series that involved eight patients. The average age of origin of this headache is 57 years. All subjects were either perimenopausal or in menopause during the beginning of headaches.

The syndrome is characterised by bilateral head pain that begins periodically from the onset and is particularly at its most critical intensity the first thing in the morning prior to awaking or while in the supine position. Instantaneous worsening in Trendelenburg seemed to be a diagnostic test for the syndrome and appeared in all participants. Many participants showed a history of episodic migraine, although the migraines were either very well managed or had stopped by the time the new headache emerged. The six out of the eight subjects were either obese or overweight, but two participants were of normal body mass index (BMI). No abnormalities were noticed during the neuroimaging. All participants answered to cerebrospinal fluid (CSF) pressure-/volume-lowering medicines, although only one subject was capable of tapering off therapy without headache recurrence completely.

This recently established subtype of chronic daily headache seems to be induced by a state of raised CSF pressure. It is assumed that a combination of the presence of cerebral venous insufficiency and an increased BMI starts this pattern of daily headache.