Diagnosis and Management of Chronic Daily Headache

Ivan Garza, M.D.; Todd J. Schwedt, M.D.

Disclosures

Semin Neurol. 2010;30(2):154-166. 

In This Article

Abstract and Introduction

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.

Introduction

Chronic daily headache (CDH) is a descriptive term that encompasses several different headache diagnoses. Chronic daily headache affects 4% of the adult population in the United States and around the world.[1–3] The vast majority of CDH patients suffer from either chronic migraine or chronic tension-type headache. Chronic daily headache results in significant pain and suffering, reduction in quality of life, and enormous economic costs to society.[4,5]

Scher has summarized the evidence from population-based studies related to risk factors influencing the incidence, prevalence, and prognosis of CDH.[6] Major life changes (residence change, marital status, etc.) have been associated with the onset of CDH.[7] Nonmodifiable factors that increase the risk for CDH include female sex, low socioeconomic status, unmarried, history of head or neck trauma, and the presence of comorbid pain disorders. Modifiable risk factors for CDH include obesity, snoring and other sleep disorders, high caffeine intake, smoking, and overuse of abortive headache medications.[6–9]

Similar to all headache types, it is essential to exclude a secondary headache as the cause of CDH. Depending upon the clinical history and examination findings, further diagnostic testing may or may not be necessary. Although a complete list of causes for secondary CDH would be exhaustive, Table 1 summarizes

If secondary headaches are ruled out, the clinician must determine the type of primary CDH the patient has. Chronic migraine, chronic tension-type headache, new daily persistent headache, hemicrania continua, and medication overuse headache are discussed in this review. Although medication overuse headache is a secondary CDH, it is included here because of the important contribution to primary CDH.

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