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Chronic Daily Headache

chronic_pictAm I having headaches too often?

iHeadache Electronic Headache Diary

Neurologists in general consider headaches that are more often than 15 days per month to be a daily headache. Patients with daily headaches or near daily headaches need a significant evaluation to determine if there is a systemic cause for which the daily headache is only a symptom.

Studies commonly performed may include imaging, blood work, and spinal taps (also known as a lumbar puncture or spinal fluid analysis). Once all secondary diseases are eliminated, then a physician is left with the considerations of the causes mentioned below. The following are just a few secondary causes of daily headache or near daily headache:

  • Brain tumors
  • Meningitis (infection of the lining of the brain)
  • Systemic infection
  • Some vitamins and herbs
  • Sleep apnea

Medication Rebound Headaches

A large number of patients with chronic daily headaches are taking daily pain medication therefore the issue of medication rebound becomes important. Headaches that are associated with the use of daily pain medication of any type (over the counter or prescription) will usually not get better without the patient discontinuing the daily pain medication. It is amazing the number of patients who state the medications that they have been taking do not help but they continue to take them anyways.

When one has daily or near daily headaches, it is important to avoid overusing pain medications. Therefore patients should not treat mild headaches at all and only treat moderate or severe headaches. Migranal, a nasal form of DHE-45, and short-term use of steroids are sometimes used to treat rebound headaches. Once it is explained that their headaches will not get better without discontinuing the daily medication, many patients can do this as an outpatient. However, sometimes patients have to be admitted to the hospital to achieve this. If admitted, it is customary to place these patients on injections of DHE-45 in order to more rapidly stop the headaches.

New Daily Persistent Headache

Some patients will suddenly have a persistent daily headache but have a history of never having an intermittent headache of any type. They have no significant pain medication use therefore they are not having rebound headaches. Their symptoms will be very similar to the three other groups of daily headaches (intermittent migraine evolving to chronic migraine, episodic tension-type headache evolving to chronic tension-type headache, and medication overuse headaches). This group is diagnosed as new daily persistent headache.

Originally the International Headache Society (IHS) {Cephalgia 2004;24 (Suppl 1)} system of classification did not differentiate between different types of near daily headache. This has been corrected in the new system (IHCD II), but studies based on this are just now starting. It is unclear how best to treat patients who suddenly begin to develop daily headaches except to say this group is evaluated very extensively for a systemic cause of their headache.

Other Types of Daily Headaches

Patients who previously had intermittent migraines and then developed daily headache are treated with the medications outlined in migraine prevention. Patients who previously had episodic tension-type headaches and then began to have daily headaches are treated according to the medications outlined on the chronic tension-type headache. There is a lot of overlap of medications. Unfortunately, when migraine and tension headaches become chronic and daily, their symptoms seem to become more alike.

Some daily headache types are quite clear - such as chronic cluster headache. In this case, the headaches keep their typical characteristics of cluster headache and just become present on a daily or near daily basis for an extended length of time.

Help Your Doctor Help You - Keep a Headache Diary

Dr. Loftus believes very strongly that data about your headaches is essential to get the best headache care.  Dr. Loftus designed and developed an app called iHeadache to gather this information. iHeadache is available for iPhone, iPod touch, and BlackBerry and records medication, disability, possible triggers and symptoms. Learn more about iHeadache at www.iHeadache.com.