Chronic daily headache

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By James R Couch MD PhD and Chaouki Khoury MD

Chronic daily headache is a highly prevalent problem affecting 3% to 5% of the population as determined by studies in many parts of the world. The syndrome consists mainly of chronic migraine and chronic tension-type headaches. Chronic daily headache produces intermittent disability and a great deal of economic and psychosocial burden with loss of time from work, from family responsibilities, and from recreational activities. Chronic daily headache often leads to the overuse of symptomatic headache and pain medications and then to an additional dimension of medication overuse or rebound-withdrawal headache. Much progress has been made in the understanding and management of this condition. This review summarizes the background and this progress, primarily focusing on chronic migraine and chronic tension-type headache.

Key points

  • Chronic daily headache is a complex chronic problem with long-term relapses and remissions.
  • The disease may have long-term psychosocial effects that drastically alter relations to family and job.
  • There is no “cure.” However, many patients can have a good response to appropriate management.
  • Management of chronic daily headache requires ongoing contact between patient and physician, and the understanding of this condition as a potentially chronic disease with pain and psychosocial morbidity. There must be ongoing vigilance to the factors noted above. Subjects often relapse into periods of frequent headache and may become discouraged or depressed.
  • There is often occurrence of medication overuse headache as a complication of treatment of chronic daily headache, or relapse of medication overuse headache due to the original medication overuse headache inducing agent, or due to another symptomatic medication that has become a new medication overuse headache inducing agent.
  • All these factors require the patient and physician to have a good understanding of the disease and its course and to work together to achieve the best outcome.

In This Article

Historical note and nomenclature
Clinical manifestations
Clinical vignette
Pathogenesis and pathophysiology
Differential diagnosis
Diagnostic workup
Prognosis and complications
References cited