Chronic Daily Headache (CDH), while not an officially recognized diagnostic entity at this time, is a well-known condition commonly seen in headache clinics throughout the country. In practice, when patients have 15 or more days of headache a month for 3 consecutive months, and no underlying medical condition explaining the headaches, they are said to suffer from “Chronic Daily Headache.” Roughly 4% of the adult population suffers from CDH. It is a painful and debilitating condition that affects its sufferers physically, socially, and mentally.
DIAGNOSIS
Chronic Daily Headache is a primary headache disorder, as the pain is not secondary to an underlying condition such as infection, inflammation, or tumor. Most patients with CDH have long-duration headaches, which by definition last 4 hours or longer. Within this category are various headache subtypes including Chronic Migraine, Chronic Tension-Type Headache, Cluster Headache Variant (Hemicrania Continua), and New Daily Persistent Headache. Chronic Migraine is defined as a headache on 15 or more days per month, and at least half of which must fulfill the criteria for migraine headache, and for 4 or more hours. Migraine headaches are generally one-sided, pulsating headaches that are moderate to severe in intensity and accompanied by light and sound sensitivity, nausea, and made worse by routine activity. Frequently, patients transform from episodic migraines (less than 15 days a month) to chronic migraines over time. There are certain factors discussed later, which make certain individuals more likely to transform than others. Chronic tension-type headache is defined as a tension type headache on 15 or more days a month. Tension-type headaches cause mild to moderate pain described as a “band-like” pressure around the head. They are not associated with nausea or vomiting and can have either light or sound sensitivity but not both. New Daily Persistent Headache (NDPH) is also a pressure-like, bilateral headache. However, it must occur daily within 3 days of onset. This differs from Chronic Tension-Type and Chronic Migraine, which usually transform from episodic to chronic over months to years. Many patients with NDPH, because they have no
previous episodic headache history, are able to tell the physician precisely what day the headache started. The onset of NDPH may directly follow a viral illness or surgery but this is not required for diagnosis. Finally, Cluster Variant Headache (Hemicrania Continua) is a continuous baseline pain on one side of the head with superimposed painful exacerbations. These exacerbations are accompanied by redness or tearing of the eye, nasal congestion or runny nose, or eyelid drooping—all occurring on the same side as the pain. Medication Overuse Headache, while not a primary headache disorder, is often very difficult to separate from the other long-duration chronic headaches. They are likely to occur when a prescription for acute therapy such as a triptan, opioid, or butalbital-containing drug is used more than 10 days in a month, or an over-the-counter medication such as Advil, Excedrin, or Tylenol, on more than 15 days, for 3 consecutive months. CDH patients often develop Medication Overuse Headaches in addition to their underlying primary headache disorder, such as migraine or tension-type headache. Because people experiencing daily pain frequently take something daily to alleviate their symptoms, it is difficult to distinguish which headaches are caused by the overuse of medication and which are part of their underlying primary headache disorder.
RISk FActORS FOR chRONIFIcAtION
Studies have shown that certain risk factors make some patients more likely to develop chronic headaches than others. For example, we know being female increases your chances of developing more frequent headaches. The same is true for obesity, low socioeconomic status, sleep apnea, medication overuse, and having a positive family history for chronic headaches. Patients who suffer from anxiety, depression, undergo a major life stressor, or suffer head trauma are also at an increased risk for the development of chronic daily headaches. Some of these risk factors cannot be avoided or altered. Those which can, such as sleep apnea, obesity, depression, and anxiety should be diagnosed and addressed to improve headache outcomes.
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National Headache Foundation
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