Neurological Sciences

, Volume 28, Supplement 2, pp S78–S83 | Cite as

Managing the “difficult” headache patient



This article reviews the challenges in managing the more complicated headache patient. These patients often have chronic daily headache or high-frequency disabling migraine. Some patients have problems adhering to treatment regimens, which may reduce treatment efficacy and in some patients lead to medication misuse and overuse. Medication overuse may transform headache to daily and reduce the effectiveness of acute and preventive therapies. There is an elevated risk of mood and anxiety disorders in migraine, with even greater risk in chronic migraine. Personality disorders may further compromise treatment efforts. Current research is reviewed on these issues and clinical suggestions are provided for more effective management of these challenging patients.

Key words

Migraine Chronic daily headache Medication overuse headache Psychiatric comorbidity Adherence 

Copyright information

© Springer-Verlag Italia 2007

Authors and Affiliations

  1. 1.New England Institute for Behavioral MedicineStamfordUSA

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