Skip to main content

Advertisement

SpringerLink
Log in

Update on Chronic Daily Headache

  • Headache
  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Opinion statement

Chronic daily headache (CDH), defined as a primary headache occurring at least 15 days per month, is a problem of worldwide scope, which is seen in 3% to 5% of the population. Though it has been recognized since ancient times, only recently have there been attempts to define and classify it. CDH usually consists of a mixture of migraine and tension-type headaches (TTH), with the more severe headaches having migraine features and the less severe headaches fitting the definition of TTH. Some patients have pure chronic TTH and no migrainous features, and others have only migraine, but most have a mixed migraine-TTH pattern. New daily persistent headache, a CDH pattern that comes on over a few days, constitutes 9% to 10% of this group and is otherwise indistinguishable from CDH. Hemicrania continua (1% of CDH) appears to be unique in being absolutely responsive to indomethacin. Accurate diagnosis of CDH is critical to management, as all organic etiologies of chronic headache must be ruled out. Problems often associated with CDH and complicating the diagnosis are head injury or medication overuse (rebound-withdrawal headache). These accompanying issues must be recognized and treated appropriately in the management plan. Finally, psychiatric problems (unipolar depression, bipolar disease, generalized anxiety disorder, and obsessive/compulsive disorder) often accompany CDH, as they are comorbid with migraine. These conditions must be recognized and treated along with the headache itself for treatment to succeed fully. Treatment of CDH is multimodal. The cornerstone of therapy is the use of prophylactic antimigraine medications to prevent or modulate the next headache. Amitriptyline, topiramate, valproic acid, and gabapentin have all had class I studies showing effectiveness in reducing headache occurrence. Recent studies with botulinum toxin have also shown effectiveness in reducing the headache burden. Recognition and treatment of medication overuse headache (MOH) must be carried out as part of the initial approach. Use of acute symptomatic treatments such as triptans or NSAIDs must be undertaken with care, as frequent use of these agents can lead to MOH. Educating the patient about the condition and reasonable expectations for therapy is essential to success. Recognition and appropriate treatment of psychiatric disorders is likewise essential. Adjunctive nondrug therapies and lifestyle changes round out the requirements for a management plan. The chances for long-term remission or significant improvement are up to 65%. The patient and physician must understand that CDH is a long-term process with relapses and remissions. A strong and trusting relationship between patient and physician is a major asset in managing this condition.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1

Similar content being viewed by others

References and recommended reading

Papers of particular interest, published recently, have been highlighted as: • Of importance•• Of major importance

  1. Critchley M: Migraine: from Cappadocia to Queen Square. In Background to Migraine: Volume 1. By Smith R. London: Heinemann; 1967.

    Google Scholar 

  2. Mathew NT, Stubits E, Nigam MP: Transformation of episodic migraine into daily headache. Analysis of factors. Headache 1982, 22:66–8.

    Article  CAS  PubMed  Google Scholar 

  3. Mathew NT, Reuveni U, Perez F: Transformed or evolutive migraine. Headache 1987, 27:102–6.

    Article  CAS  PubMed  Google Scholar 

  4. Headache Classification Committee of the International Headache Society: Classification and diagnostic criteria for headache disorders, cranial neuralgia, and facial pain. Cephalalgia 1988, 8(Suppl 7):1–96.

    Google Scholar 

  5. Silberstein SD, Lipton RB, Sliwinski M: Classification of daily and near-daily headaches: field trial of revised IHS criteria. Neurology 1996, 47:871–5.

    CAS  PubMed  Google Scholar 

  6. Headache Classification Committee of the International Headache Society: The international classification of headache disorders. Cephalalgia 2004, 24(Suppl 1):1–160.

    Google Scholar 

  7. Headache Classification Committee, Olesen J, Bousser MG, et al.: New appendix criteria open for a broader concept of chronic migraine. Cephalalgia 2006, 26(6):742–6.

    Article  CAS  PubMed  Google Scholar 

  8. Seshia SS, Woeber-Bingoel C, Guidetti V: The classification of chronic headache: room for further improvement? Cephalalgia 2010, 30(10):1268–70.

    Article  CAS  PubMed  Google Scholar 

  9. Midgette LA, Scher AI: The epidemiology of chronic daily headache. Curr Pain Headache Rep 2009, 13(1):59–63.

    Article  PubMed  Google Scholar 

  10. Da Silva A, Coelho Costa E, Bosco Gomes J, et al.: Chronic headache and comorbidities: a two-phase, population-based, cross-sectional study. Headache 2010, 50:1306–12.

    Article  PubMed  Google Scholar 

  11. Scher AI, Stewart WF, Liberman J, Lipton RB: Prevalence of frequent headache in a population sample. Headache 1998, 38:497–506.

    Article  CAS  PubMed  Google Scholar 

  12. Castillo J, Munoz P, Guitera V, et al.: Epidemiology of chronic daily headache in the general population. Headache 1999, 39:190–6.

    Article  CAS  PubMed  Google Scholar 

  13. Wang SJ, Fuh JL, Lu SR, Lui CY, Hsu LC, Wang PN: Chronic daily headache in Chinese elderly: prevalence, risk factors, and biannual follow-up. Neurology 2000, 54:314–9.

    CAS  PubMed  Google Scholar 

  14. Wiendels NJ, Knuistingh Neven A, et al.: Chronic frequent headache in the general population: prevalence and associated factors. Cephalalgia 2006, 26:1434–42.

    Article  CAS  PubMed  Google Scholar 

  15. Theeler BJ, Flynn FG, Erickson JC: Headaches after concussion in US soldiers returning from Iraq or Afghanistan. Headache 2010, 50:1262–72.

    Article  PubMed  Google Scholar 

  16. Walker WC, Seel RT, Curtiss G, Warden DL: Headache after moderate and severe brain injury: a longitudinal analysis. Arch Phys Med Rehabil 2005, 86:1793–800.

    Article  PubMed  Google Scholar 

  17. Neely ET, Midgette LA, Scher AI: Clinical review and epidemiology of headache disorders in US service members: with emphasis on post-traumatic headache. Headache 2009, 49:1089–96.

    Article  PubMed  Google Scholar 

  18. Couch JR, Bearss C: Chronic daily headache in the posttrauma syndrome: relation to extent of head injury. Headache 2001, 41:559–64.

    Article  CAS  PubMed  Google Scholar 

  19. Couch JR, Lipton RB, Stewart WF: Head or neck injury increases the risk of chronic daily headache. A population-based study. Neurology 2007, 69:1169–77.

    Article  PubMed  Google Scholar 

  20. Couch JR, Lenaerts ME: Medication overuse headache: clinical features, pathogenesis and management. Drug Dev Res 2007, 68:1–12.

    Article  Google Scholar 

  21. Lenaerts ME, Couch JR: Medication overuse headache. Minerva Med 2007, 98:221–31.

    CAS  PubMed  Google Scholar 

  22. Diener HC, Limmroth V: Medication-overuse headache: a worldwide problem. Lancet Neurol 2004, 3:475–83.

    Article  PubMed  Google Scholar 

  23. Scher AI, Stewart WF, Ricci JA, Lipton RB: Factors associated with the onset and remission of chronic daily headache in a population-based study. Pain 2003, 106:81–9.

    Article  CAS  PubMed  Google Scholar 

  24. Couch JR: Chronic daily headache. Curr Treatm Opt Neurol 2003, 5:467–79.

    Article  Google Scholar 

  25. Couch JR: Can medication overuse headache be treated by abrupt withdrawal of the overused agent? Nat Clin Pract Neurol 2006, 2:654–5.

    Article  PubMed  Google Scholar 

  26. Lu SR, Fuh JL, Chen WT, Juang KD, Wang SJ: Chronic daily headache in Taipei, Taiwan: prevalence, follow-up and outcome predictors. Cephalalgia 2001, 21:980–6.

    Article  CAS  PubMed  Google Scholar 

  27. Bigal ME, Lipton RB: Modifiable risk factors for migraine progression. Headache 2006, 46:1334–43.

    Article  PubMed  Google Scholar 

  28. Bigal ME, Serrano D, Buse D, Scher A, Stewart WF, Lipton RB: Acute migraine medications and evolution from episodic to chronic migraine: a longitudinal population-based study. Headache 2008, 48:1157–68.

    Article  PubMed  Google Scholar 

  29. Scher AI, Midgette LA, Lipton RB: Risk factors for headache chronification. Headache 2008, 48:16–25.

    Article  PubMed  Google Scholar 

  30. Burstein R, Jakubowski M, Garcia-Nikas E, Kainz V, Bajwa Z, Hargreaves R, Becerra L, Borsook D: Thalamic sensitization transforms localized pain into widespread allodynia. Ann Neurol 2010, 68:81–91.

    Article  PubMed  Google Scholar 

  31. De Felice M, Ossipov MH, Wang R, et al.: Triptan-induced latent sensitization a possible basis for medication overuse headache. Ann Neurol 2010, 67:325–37.

    PubMed  Google Scholar 

  32. Supornsilpchai W, le Grand SM, Srikiatkhachorn A: Cortical hyperexcitability and mechanism of medication-overuse headache. Cephalalgia 2010, 30:1101–9.

    Article  PubMed  Google Scholar 

  33. Hamelsky SW, Lipton RB: Psychiatric comorbidity of migraine. Headache 2006, 46:1327–33.

    Article  PubMed  Google Scholar 

  34. Stewart WF, Lipton RB, Kolodner K, Liberman J, Sawyer J: Reliability of the migraine disability assessment score in a population-based sample of headache sufferers. Cephalalgia 1999, 19:107–14.

    Article  CAS  PubMed  Google Scholar 

  35. Lance JW, Curran DA: Treatment of chronic tension headache. Lancet 1964, 1:1236–9.

    Article  CAS  PubMed  Google Scholar 

  36. Lance JW, Curran DA, Anthony M: Investigations into the mechanism and treatment of chronic headache. Med J Aust 1965, 2:909–14.

    CAS  PubMed  Google Scholar 

  37. Diamond S, Baltes BJ: Chronic tension headache—treated with amitriptyline—a double blind study. Headache 1971, 11:110–5.

    Article  CAS  PubMed  Google Scholar 

  38. Couch JR, Hassanein RS: Amitriptyline in migraine prophylaxis. Arch Neurol 1979, 36:695–9.

    CAS  PubMed  Google Scholar 

  39. Couch JR. Amitriptyline in the prophylactic treatment of migraine and chronic daily headache. Headache 2011 (in press).

  40. Evans RW: The FDA alert on serotonin syndrome with combined use of SSRIs or SNRIs and triptans: an analysis of the 29 case reports. MedScape Gen Med 2007, 9(3):48.

    Google Scholar 

  41. Diener HC, Bussone G, Van Oene JC, et al.: Topiramate reduces headache days in chronic migraine: a randomized, double-blind, placebo-controlled study. Cephalalgia 2007, 27:814–23.

    Article  PubMed  Google Scholar 

  42. Silberstein SD, Lipton RB, Dodick DW, et al.: Efficacy and safety of topiramate for the treatment of chronic migraine: a randomized, double-blind, placebo-controlled trial. Headache 2007, 47:170–80.

    Article  PubMed  Google Scholar 

  43. Spira PJ, Beran RG, Gabapentin Chronic Daily Headache Group: Gabapentin in the prophylaxis of chronic daily headache. A randomized, placebo-controlled study. Neurology 2003, 61:1753–9.

    CAS  PubMed  Google Scholar 

  44. Freitag FG, Diamond S, Diamond ML, Urban GJ: Divalproex in the long-term treatment of chronic daily headache. Headache 2001, 41:271–8.

    Article  CAS  PubMed  Google Scholar 

  45. Yurekli VA, Akhan G, Kutlihan S, Uzar E, Koyuncuoglu HR, Gultekin F: The effect of sodium valproate on chronic daily headache and its subgroups. J Headache Pain 2008, 9:37–41.

    Article  CAS  PubMed  Google Scholar 

  46. Aurora SK, Dodick DW, Turkel CC, et al.: OnabotulinumtoxinA for treatment of chronic migraine: Results from the double-blind, randomized, placebo-controlled phase of the PREEMPT 1 trial. Cephalalgia 2010, 30(7):793–803.

    Article  CAS  PubMed  Google Scholar 

  47. Diener HC, Dodick DW, Aurora SK, et al.: OnabotulinumtoxinA for treatment of chronic migraine: Results from the double-blind, randomized, placebo-controlled phase of the PREEMPT 2 trial. Cephalalgia 2010, 30(7):804–14.

    Article  CAS  PubMed  Google Scholar 

  48. Schoenen J: Botulinum toxin in headache treatment: Finally a promising path? Cephalalgia 2010, 30(7):771–3.

    Article  PubMed  Google Scholar 

  49. Blumenfeld A, Silberstein SD, Dodick DW, et al.: Method of injection of onabotulinumtoxinA for chronic migraine: a safe, well-tolerated, and effective treatment paradigm based on the PREEMPT clinical program. Headache 2010, 50:1406–18.

    Article  PubMed  Google Scholar 

  50. Nicholson RA, Buse DC, Andrasik F, Lipton RB. Nonpharmacologic treatments for migraine and tension-type headache: how to choose and when to use. Curr Treatm Opt Neurol 2011 (in press).

  51. Taylor FR, Kaniecki RG. Symptomatic treatment of migraine: when to use NSAIDs, triptans, or opioids. Curr Treatm Opt Neurol 2011 (in press).

Download references

Disclosure

No potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

  1. Professor of Neurology, Department of Neurology, University of Oklahoma Medical School, 711 Stanton L. Young Boulevard, Suite 215, Oklahoma City, OK, 73104, USA

    James R. Couch

Authors
  1. James R. Couch
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to James R. Couch.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Couch, J.R. Update on Chronic Daily Headache. Curr Treat Options Neurol 13, 41–55 (2011). https://doi.org/10.1007/s11940-010-0104-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11940-010-0104-7

Keywords

Search

Navigation