When You Have a Headache Every Day

The Skinny on a Chronic Daily Headache

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Do you suffer from daily headaches? You may be experiencing something called a chronic daily headache or CDH. These are debilitating headache disorders that can severely impact your daily life.

What is a Chronic Daily Headache?

A chronic daily headache (CDH) is a headache that occurs for fifteen or more days per month for longer than 3 months.  A CDH can be thought of as a "chronic" form of a primary headache disorder or a disorder on its own.

Here are five types of chronic daily headaches:

  • Chronic migraine headache
  • Chronic tension-type headache
  • Hemicrania continua
  • New daily persistent headache
  • Medication overuse headache

The headache must not be a secondary headache – due to another underlying medical condition, like an infection or a tumor. Your neurologist or headache specialist will do a thorough workup to ensure this is not the case before diagnosing you with chronic daily headache.

Interestingly, CDH is more common in women and is present in about 4 percent of the adult population worldwide. Treatment is complicated and often involves multiple modalities, including both medication and behavioral therapy.

Let's briefly summarize the following headache disorders that may fit the "chronic" criteria, as defined by the International Headache Society (2013).

What is a Chronic Migraine?

A chronic migraine occurs on 15 or more days per month for at least 3 months.

For at least 8 of those days, the headache has characteristics of a migraine with aura or migraine without aura. Alternatively, chronic migraine can also occur when, for at least 8 of those days, the person believes they are having a migraine and then have relief of their headache  by taking a triptan or ergot medication.

What is a Chronic Tension-Type Headache?

A chronic tension-type headache has features of a tension-type headache and affects approximately 2% of the population, according to a study in Headache. It  occurs for 15 or more days per month for more than 3 months. The headache can be continuous or can come and go for hours or days.

What is Hemicrania continua?

Hemicrania continua is a painful, one-sided headache that occurs all the time on a daily basis without relief. It is accompanied by at least one autonomic symptom like nasal discharge, tearing of the eye, or miosis. This headache type is responsive to indomethacin, an NSAID.

What is New Daily Persistent Headache?

A new daily persistent headache (NDPH)  is a headache that occurs daily and is present all the time for more than 3 months. It generally has features similar to a tension-type headache – located on both sides of the head and causes a rubber-band-around-the-head sensation. There may be photophobia, phonophobia, or mild nausea – but only one of these symptoms, not two or three.

The pain of this type of headache is not usually worsened by regular physical activity – which is commonly present in migraines.

What is Medication Overuse Headache?

A medication overuse headache, also known as a rebound headache, occurs after regular use of a headache medication for 3 or more months – like nsaids for a tension-type headache or triptans for a migraine.

Take Home Point

The diagnosis of chronic daily headache or CDH is complicated and requires an extensive evaluation by your doctor. As always, be informed and proactive in your healthcare.

Sources:

Chronic Daily Headache and Chronic Migraine. (n.d.) In American Headache Society. Retrieved April 19th 2014, from http://www.americanheadachesociety.org/assets/1/7/NAP_for_Web_-_CDH___Chronic_Migraine.pdf.

Headache Classification Committee of the International Headache Society. "The International Classification of Headache Disorders: 3rd Edition (beta version)". Cephalalgia 2013;33(9):629-808.

Scher Al, Stewardt WF, Liberman J, & Lipton RB. Prevalence of frequent headache in a population sample. Headache. 1998;38(7):497-506.

Schwartz BS, Stewart WF, Simon D, et al. Epidemiology of tension-type headache. JAMA. 1998;279:381–3.

Silberstein SD, Lipton RB, & Sliwinski M. Classification of daily and near-daily headaches: field trial of revised IHS criteria.Neurology. 1996;47(4):871-875.

Silver N. Headache (chronic tension-type). Am Fam Physician. 2007 Jul 1;76(1):114-6.

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