Diagnosis and Management of Chronic Daily Headache

Abstract

Chronic daily headache (CDH) is a descriptive term that encompasses multiple headache diagnoses and affects $4% of the general adult population. Chronic daily headache results in significant pain and suffering with substantial impact on quality of life, and enormous economic costs to society. Although most patients with primary CDH suffer from chronic migraine or chronic tension-type headache, other primary and secondary headache disorders can also manifest as a CDH syndrome. For CDH management to succeed, secondary headaches need to be ruled out with proper investigations when judged necessary. If the diagnosis of primary CDH is established, diagnosis of the specific CDH subtype is imperative to institute appropriate treatment. The diagnosis and management of distinct CDH entities, chronic migraine, chronic tension-type headache, new daily persistent headache, and hemicrania continua, are the primary forms of CDH and the emphasis of this review. Although, strictly speaking, medication overuse headache is a secondary form of CDH, it is also highlighted in this review given its frequent association with primary CDH.

Combination of acupuncture and spinal manipulative therapy: management of a 32-year-old patient with chronic tension-type headache and migraine

“…9,22 Most CDHs are also either chronic migraines or CTTHs. 23 According to the ICHD-2, CTTHs are characterized as TTHs for at least 15 days per month, lasting at least 3 months, with less than 8 days per month meeting the criteria for migraine. 27 Tension-type headaches are described as being bilateral, nonpulsating, tightening, or squeezing sensation around the head and not aggravated by activity.…”

“…21,27 The term chronic migraine has been suggested as being more appropriate to describe migraine attacks superimposed on a background of daily TTH. 22,23 The ICHD-2 criteria use the term chronic migraine specifically when patients experience more than 8 migraines per month for more than 3 consecutive months. 27 According to the ICHD-2 criteria, migraine headaches are characterized by unilateral, moderate-tosevere pulsating pain that is aggravated by activity.…”

“…26 Most notably, the headache worsens during the period of medication overuse. 18,19,21,23 What differentiates the quality of MOHs from CTTHs most clearly is that MOHs worsen significantly with mental or physical exertion, whereas CTTHs do not. Medication overuse headaches occur in approximately 1% of the population 28 and can be a major contributing factor in the transformation of episodic headaches to CDHs.…”

“…27 Thirty percent of all CDH patients are estimated to have MOH. 20 The term transformed migraines is used to describe a progressive evolution from episodic migraine headaches to chronic migraine headaches, formerly called mixed headaches, 19 80% of the time against a background of MOH, [20][21][22][23][24][25] although this evolution can also occur without medication overuse. 25,26,[30][31][32] Some authors state that 14% of patients will transform from episodic to chronic migraine headaches.…”

“…21 Transformed migraines are not addressed in the ICHD-2. 19,[21][22][23] Migraines can be chronic, more than 8 migraines per month for 3 months according to ICHD-2 criteria, 27,30 without being transformed. Transformed migraines, which are daily or near-daily "mixed" TTH and migraine in nature, 19,28 occur predominantly in women, starting as strictly simple episodic migraines associated with or (more commonly) without auras in the teens and early 20s.…”