Chronic daily headaches: Key Points

Chronic daily headaches Overview

Most people have headaches from time to time. But if you have a headache more days than not, you may be experiencing chronic daily headaches.

The incessant nature of chronic daily headaches makes them among the most disabling headaches. Aggressive initial treatment and steady, long-term management may reduce pain and lead to fewer headaches

Primary Chronic daily headaches disorders

Patients who have successfully dealt with medication overuse may be left with chronic headaches. The nature of these headaches may be clearer once they are not taking analgesics regularly. The commonest primary diagnosis is chronic migraine, but cases of chronic cluster headache, hemicrania continua, and chronic paroxysmal hemicrania may emerge from previously unclassifiable chronic headaches.
Chronic migraine may be treated with the usual selection of prophylactic treatments. Chronic cluster headache may respond to verapamil, topiramate, lithium, methysergide, or melatonin. Chronic paroxysmal hemicrania or hemicrania continua should respond to indometacin. All the chronic trigeminal autonomic cephalgias have been shown to respond to occipital nerve stimulation in a reasonable proportion of cases.

Symptoms of Chronic daily headaches

Chronic daily headaches occur 15 days or more a month, for at least three months. True (primary) chronic daily headaches aren’t caused by another condition.

There are short-lasting and long-lasting chronic daily headaches. Long-lasting last more than four hours. They include:

• Chronic migraine
• Chronic tension-type headache
• New daily persistent headache
• Hemicrania continua

Chronic migraine

This type typically occurs in people with a history of episodic migraines. On eight or more days a month for at least three months, migraines tend to have the following features:

• Affect one side or both sides of your head
• Have a pulsating, throbbing sensation
• Cause moderate to severe pain
• Are aggravated by routine physical activity

And they cause at least one of the following:

Nausea, vomiting or both
Sensitivity to light and sound

Chronic tension-type headache

These headaches tend to have the following features:

Affects both sides of your head
Cause mild to moderate pain
Cause pain that feels pressing or tightening, but not pulsating
Aren’t aggravated by routine physical activity
Some people may have skull tenderness.

New daily persistent headache

These headaches come on suddenly, usually in people without a headache history. They become constant within three days of your first headache. They have at least two of the following characteristics:

• Usually affects both sides of your head
• Cause pain that feels like pressing or tightening, but not pulsating
• Cause mild to moderate pain
• Aren’t aggravated by routine physical activity

Hemicrania continua

These headaches:

• Affect only one side of your head
• Are daily and continuous with no pain-free periods
• Cause moderate pain with spikes of severe pain
• Respond to the prescription pain reliever indomethacin (Indocin)
• May sometimes become severe with development of migraine-like symptoms

In addition, hemicrania continua headaches are associated with at least one of the following:

• Tearing or redness of the eye on the affected side
• Nasal congestion or runny nose
• Drooping eyelid or pupil narrowing
• Sensation of restlessness

Chronic daily headaches: key points

• Chronic daily headaches (CDH) implies headache on a daily or near daily basis, for 15 days or more a month

• CDH is common in referral practice since it is usually accompanied by considerable disability

• CDH may be seen in both primary and secondary headache forms; the latter need careful consideration, while the primary forms are more common

• The two most common forms of CDH are chronic migraine and chronic tension type headache

• Chronic migraine implies that the patient has 15 days or more a month of headache that is biologically migrainous, not that each attack fulfils standard criteria for migraine because they often do not

• Medication overuse is a common complicating issue in CDH; it consists of using an acute attack treatment more than two days a week regularly, usually with the dose escalating over time

• Stopping medication overuse will improve many but not all patients with CDH, although it is essential since concomitant overuse significantly reduces the effectiveness of headache preventative medications