One of the conditions we treat on an ongoing basis at the National Headache Institute is the chronic daily headache, or CDH. This is a term used to describe any headache that recurs almost daily. These can include chronic tension headaches, transformed migraines, and chronic migraines.
CDH is most often applied to headaches, not related to illness, occurring at least 15 times a month. Chronic tension-type headaches are daily or near daily headaches occurring in patients who have experienced episodic tension headaches in the past.
Chronic tension-type headaches tend to be bilateral or diffuse, often involving both sides of the head, or the back of the head and neck. They cause mild to moderate pain, including pain that feels pressing, but not pulsating. Some people may feel tenderness in the skull.
The experts at National Headache Institute have found that transformed migraine and chronic migraine sufferers are almost exclusively women. Most began experiencing migraines in young adulthood and usually have a family history of depression, panic disorders, or alcohol abuse. Eighty percent of transformed migraine patients suffer from depression, and the same percentage of chronic migraine patients overuse medication. The most common experience is of migraines that are more frequent over time, developing into a daily, or near daily pattern.
Transformed and chronic migraines are similar to tension headaches. They are not usually associated with neurological or gastrointestinal conditions. Transformed migraines can develop from overuse of medication but can also occur without it.
Treatment of chronic daily headache must take into account the treatment of any associated psychiatric disorder, if present.
Preventative treatments may be needed including calcium channel blockers, anticonvulsants, beta-blockers, and antidepressants, sometimes in combination. Non-pharmacologic therapy can include behavioral psychotherapy and lifestyle changes.
DO YOU HAVE A CHRONIC HEADACHE DISORDER?
We often hear from our patients that due to their nature, chronic daily headaches can be among the most disruptive and severe of all headache disorders. Their very nature make chronic headaches a potentially debilitating condition and tend to be among the most difficult headache disorders to treat.
Chronic headaches are not a symptom of another medical condition and can vary greatly in duration, usually around four hours. Those lasting longer are categorized into four types; chronic migraines, new daily persistent headaches, chronic tension-type headaches and hemicrania continua.
Chronic migraines develop from episodic migraines not accompanied by aura and with moderate or severe episodes of a throbbing pain on one part of the head. Chronic migraines are worsened by physical exertion and may cause increased sensitivity to sound and light.
Chronic tension-type headaches can evolve from episodic tension headaches that are described as mild to moderate pressure like pain. These headaches affect both sides of the head instead of a specific region. Chronic tension-type headaches have associated symptoms like heightened sound and light sensitivity and nausea.
New daily persistent headaches are very similar in description to chronic tension-type headaches. The principal difference is that they increase in frequency very quickly after the first onset. Hemicrania continua is characterized by a constant, moderate pain on the side of the head sometimes with intermittent moments of severe pain. They can last several days with no periods of relief. In some patients they bring on symptoms associated with migraines as well and runny nose. Another common development is eye redness, decreased pupils and a drooping eyelid, all on the side of the head affected by the pain.
Drug Overuse Can Increase Headache Pain Recurrence
Overuse of opiates, analgesics, and ergot-amines can go hand in hand with chronic daily headache. Medication overuse can lead to what are called rebound headaches, which can lead to medication dependency. The most common history is of an episodic migraine converted to a transformed migraine through overuse of medication.
Treatment of these types of headaches begins with discontinuing use of the offending drug and preparing for possible withdrawal symptoms. If the dependency is advanced, withdrawal is done gradually over a period of weeks.
When To Consult A Doctor
People who suffer two or more headaches a week and who take pain relievers for headaches most days should see a doctor. This also applies to those who see their headache patterns change or worsen, or if the headaches are disabling.
Prompt medical care should be sought if the headache is sudden and severe, is accompanied by fever, stiff neck, numbness, a seizure or double vision, follows a head injury, or gets worse despite rest and pain medication.