From Episodic to Chronic: A Discussion on Headache Transformation

  • Anna PaceEmail author
  • Bridget Mueller


A chronic daily headache (CDH) disorder is a very different illness than the more common episodic headache. While the episodic headache patient must cope with the uncertainty of when and where the next attack will occur, the CDH patient is frequently faced with relentless pain. This chapter aims to answer several questions:

First, how do we define CDH and what is the burden, to the individual and society, of this disorder?

Three to four percent of the worldwide population suffers from a chronic daily headache disorder encompassing chronic migraine, chronic tension-type headache, hemicrania continua, and new daily persistent headache. Second, what do we know about the mechanism underlying the transformation from episodic headache to CDH? We review evidence suggesting an underlying genetic vulnerability and involvement of glutamate, calcitonin-related peptide, and serotonin pathways. Finally, what risk factors shift an episodic headache to a daily or near-daily headache? The impact of medication overuse, obesity, sleep disturbances, stress, depression, and menstrual-related migraines on headache progression is discussed.

Our hope is that a greater understanding of headache transformation will lead to novel treatment approaches. At the very least, an awareness of modifiable risk factors may empower patients and help prevent an episodic headache from transforming to a chronic daily headache disorder.


Chronic daily headache Transformed migraine Chronic tension-type headache Headache transformation 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of NeurologyIcahn School of Medicine at Mount SinaiNew YorkUSA

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