Chronic daily headache: how to manage it?

Abstract

The role of daily analgesic use (also called abuse) in chronic daily headache (CDH) for the maintenance of chronic headache is discussed. The comprehension of the underlying mechanisms of actions is lacking mainly because of the absence of animal models. The abuse should be considered as a compulsive behavior rather than linked to the type of analgesic used and related both to "how" the drug is taken and to "what" drug is used. Moreover, there is no evidence of addictive personality in these patients, and also predictive factors for the long-term outcomes are inconsistent. In the literature specific indications are lacking for the treatment to be performed in these patients. In conclusion, the main problem for these patients is to manage their headaches, and the aim of the therapy should be to enable patients to feel in control of their migraine rather than feel that migraine or analgesic drugs control them.

Advice Alone Vs. Structured Detoxification Programmes for Medication Overuse Headache: A Prospective, Randomized, Open-Label Trial in Transformed Migraine Patients With Low Medical Needs

“…Drug withdrawal is the treatment of choice for MOH (4)(5)(6)(7)(8)(9). Currently, there are no universally accepted standardized therapeutic protocols and no specific guidelines for controlled trials in MOH (4,(6)(7)(8)10). Almost no prospective placebo-controlled trials have been conducted in this field, in which treatment effectiveness is inferred from the results of open-label trials, retrospective case reviews, anecdotal observations, clinical experience and generalization from the literature on the primary headaches.…”

Topo–kinesthetic memory in chronic headaches. A new test for chronic patients: preliminary report

“…First of all, in this study we observed that MOH patients responded well in reducing drug overuse by following a standard protocol to treat overuser patients [19,20]. In this series the HI did not change significantly because almost all patients continued to complain of near daily headache.…”