Chronic Daily Headaches
Chronic daily headache (CDH) is defined as headaches that occur for 15 days or more in a month, at least for 3 months. Therefore, it is not a diagnosis per se. 4% of the population is affected by CDH.
Presentation
Short-duration chronic daily headache (CDH) are brief headache syndromes and trigeminal autonomic cephalalgias. They are relatively rare and only a small proportion of CDH patients are affected by them [1] [2].
The trigeminal autonomic cephalalgias have autonomic features with unilateral trigeminal distribution, these include paroxysmal hemicrania, chronic cluster headache, and short-lasting unilateral neuralgiform attacks with autonomic cranial symptoms or conjunctival tearing and injection.
Brief headache syndromes are primary stabbing, primary exertional, primary cough, and hypnic headaches.
Most cases with long-duration CDH are affected by migraines or tension-type headaches. Other types include new daily persistent headache and hemicrania continua [3].
The term "transformed migraine" is used to describe chronic migraines in patients with a gradual or rapid progression to CDH with flare-ups similar to their previous episodes of a migraine [4].
Medication overuse further complicates treatment in two-thirds of patients who regularly use abortive medication such as acetaminophen, caffeine, non-steroidal anti-inflammatory drugs, triptans, and narcotics.
In tension-type headaches, bilateral or occipital bandlike discomfort build up in a slow way and can last for several days. Unlike migraines, nausea and photophobia are generally absent. If a headache becomes constant in 72 hours it is new daily persistent headache instead of chronic tension-type headache which develops more slowly.
New daily persistent headache is more refractory to treatment compared to chronic tension-type headache.
Patients who progress to CDH may have symptoms of both a migraine and tension-type headaches which result in a challenging treatment planning [5].
Neurologic
Headache
- If a headache becomes constant in 72 hours it is new daily persistent headache instead of chronic tension-type headache which develops more slowly.[symptoma.com]
- METHODS: A Headache Center to characterize headaches in children (3 to 18 years old) was established. Over 34 months, 577 children have been evaluated. With use of a definition of or 15 headaches per month, 200 (34.6%) children had CDH.[ncbi.nlm.nih.gov]
- The simplest definition of CDH is 15 headache days per month. In the international headache society (IHS) criteria, only chronic tension-type headaches and chronic cluster headaches are recognised as CDH.[ncbi.nlm.nih.gov]
- The average time interval for the evolution of sporadic headache into chronic daily headache was 1.4 years, and psychosocial stressors were present, acutely or chronically, during the period of headache-frequency increase in 47% of the children.[ncbi.nlm.nih.gov]
- TACs include episodic and chronic cluster headache, episodic and chronic paroxysmal hemicrania, SUNCT, and hypnic headache.[ncbi.nlm.nih.gov]
Recurrent Headache
- The long-term goals of this study are to reduce the symptoms that are associated with recurrent headaches and to collect data that can be used for future acupuncture studies.[clinicaltrials.gov]
- Sustained or recurrent headaches can greatly impact school performance and may even induce behavioral disturbances. 1 Headache accounts for approximately 1% of all pediatric ED visits. 2,3 Fortunately, most headaches in children prompting an ED visit[accessmedicine.mhmedical.com]
- Headache disorders, characterized by recurrent headache, are among the most common disorders of the nervous system.[who.int]
Workup
If primary CDH is diagnosed, detection of the subtype is necessary to plan appropriate treatment accordingly.
Secondary causes of headaches have to be excluded before forming a management plan for CDH.
Evaluation of red flags is important as they suggest a secondary etiology for a headache [3] [6].
Red flags and their suggestive etiologies:
- A headache that is aggravated or relieved by an upright or supine position: intracranial hemorrhage
- A headache provoked by the Valsalva maneuver: Arnold-Chiari malformation
- Sudden onset of a headache: Subarachnoid hemorrhage
- Onset after 50 years: Brain neoplasm
- Papilledema: Increased intracranial pressure
- Lateralizing or focal neurologic signs: Hemorrhagic stroke
- Systemic symptoms (fever, weight loss, myalgias): Meningitis, giant cell arteritis, encephalitis
- Recent pregnancy: Postpartum preeclampsia
Imaging studies must be ordered when red flags are observed [5]. Magnetic resonance imaging (MRI) is considered the most useful method since it has a higher sensitivity to detect secondary causes of headaches compared to computed tomography (CT). In absence of contraindications, MRI with contrast should be ordered, especially when an intracranial mass is suspected. CT scans are more appropriate for acute settings to exclude intracranial mass or hemorrhage. Primary headaches do not have specific MRI findings.
CDH results in a reduction in quality of life, high economic costs for the society and significant pain and suffering for the patient [7] [8].
Treatment
- Our experience with intravenous treatment of headaches and migraines was summarized recently and a 97.5% success rate for this type of treatment was found in the clinic.[ncbi.nlm.nih.gov]
- OBJECTIVE: In this review, we focus on nonmedication treatment approaches to chronic daily headaches and chronic migraine.[ncbi.nlm.nih.gov]
- New daily persistent headache is more refractory to treatment compared to chronic tension-type headache. Patients who progress to CDH may have symptoms of both a migraine and tension-type headaches which result in a challenging treatment planning.[symptoma.com]
- Compared with the treatments commonly available in the emergency department, the specialist’s clinic can offer more effective headache-altering definitive treatments.[link.springer.com]
- The site discusses physiologic dental treatment to eliminate and/or reduce all of these types of headaches and related orofacial pain.[thinkbetterlife.com]
Prognosis
- The diagnosis, classification, treatment, and long-term prognosis continue to be poorly understood. Recent epidemiologic studies and updated classifications have been done in this area, but further work is needed to help these children.[ncbi.nlm.nih.gov]
- […] worse prognosis at follow-up.[migrainetrust.org]
- Seventy-six cases of presumed sudden hearing loss occurring in 1973: Prognosis and incidence . Laryngoscope 1977 ; 87: 817 – 825 . Google Scholar Crossref Medline ISI 3. Schreiber, BE, Agrup, C, Haskard, DO. Sudden sensorineural hearing loss .[doi.org]
- Prognosis Generally, CH is a lifelong problem.[emedicine.com]
Etiology
- Evaluation of red flags is important as they suggest a secondary etiology for a headache.[symptoma.com]
- Transformed migraine was determined to be the etiology in the majority (35/50; 70%), with a minority attributable either to postconcussion syndrome (7/50; 14%) or new daily persistent headaches (6/50; 12%).[ncbi.nlm.nih.gov]
- CONCLUSIONS: Carnitine palmityltransferase II deficiency may represent another etiology for migraine headache, and may be useful in further defining the pathophysiology of migraine.[ncbi.nlm.nih.gov]
- Table 159-1 Etiology of Headache View Table Favorite Table Download (.pdf) Table 159-1 Etiology of Headache Critical Secondary Causes Reversible Secondary Causes Vascular conditions Non–central nervous system infections Subarachnoid hemorrhage Focal Intraparenchymal[accessmedicine.mhmedical.com]
- We aimed to systematically review the evidence of using intravenous and/or oral niacin as a treatment for migraine headaches, tension-type headaches, and for headaches of other etiologic types.[ncbi.nlm.nih.gov]
Epidemiology
- The evolution of the classification of chronic daily headache has aided epidemiologic efforts. The disorder can be primary or related to other neurologic or systemic conditions.[ncbi.nlm.nih.gov]
- Recent epidemiologic studies and updated classifications have been done in this area, but further work is needed to help these children.[ncbi.nlm.nih.gov]
- (see Sleep and Health article on Physiologic dentistry) A September 2009 article in HEADACHE “Headache and Symptoms of Temporomandibular Disorder: An Epidemiological Study” concluded that ” Temporomandibular disorder symptoms are more common in migraine[thinkbetterlife.com]
- , Technische Universität München 3 Department of Neurology, Technische Universität München 4 Institute of Social Medicine, Epidemiology, and Health Economics, Charité University Medical Centre, Berlin, Germany 5 Private practice, Munich 6 Department of[doi.org]
- The fact that migraine and primary fibromyalgia share some pivotal set-up of serotonergic and excitatory amino acid systems led us to analyse epidemiological data supporting the hypothesis that analgesic disruption and a consequent hyperalgesic state[ncbi.nlm.nih.gov]
Pathophysiology
- Carnitine is used by mitochondria for fatty acid transportation; its deficiency, however, has not been implicated in migraine pathophysiology.[ncbi.nlm.nih.gov]
- The pathophysiology of MOH is complex, and there certainly is a genetic predisposition toward MOH as well.[practicalpainmanagement.com]
- Increased expression of arginase has been reported in several inflammatory lung diseases, including allergic asthma, suggesting that this may be a common feature underlying the pathophysiology of airway hyperreactivity.[ncbi.nlm.nih.gov]
- CONCLUSION: There is evidence of oxidative stress in migraine pathophysiology. Following treatment, oxidative stress declined following both pharmacological and rTMS.[ncbi.nlm.nih.gov]
Prevention
- Some anti-seizure drugs seem to prevent migraines. These medications may be used to prevent chronic daily headaches as well. Options may include gabapentin (Neurontin) and topiramate (Topamax). NSAIDs.[hoag.org]
- Treatment and management involve a multidisciplinary approach, including acute therapy for when the headache severity increases (while avoiding medication overuse), preventative therapy to reduce the frequency and impact of the CDH, and biobehavioral[ncbi.nlm.nih.gov]
- They tend to be females in the midteen years experiencing a transformed migraine complicated by analgesic abuse, suggesting potential preventability.[ncbi.nlm.nih.gov]
- It reduces the intensity of the pain and prevents its frequent occurrence. Biofeedback is another way of reducing the occurrence of chronic daily headaches.[epainassist.com]
- […] were not associated with greater benefit than placebo for preventing episodic migraine or chronic tension-type headaches, according to an article in the April 25 issue of JAMA .[sciencedaily.com]
References
Article
- Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders: 2nd edition. Cephalalgia. 2004;24(suppl 1):9–160.
- Matharu MS, Goadsby PJ. Trigeminal autonomic cephalgias. J Neurol Neurosurg Psychiatry. 2002;72 suppl 2:ii19–ii26.
- Halker RB, Hastriter EV, Dodick DW. Chronic daily headache: an evidence-based and systematic approach to a challenging problem. Neurology. 2011;76(7 suppl 2):S37–S43.
- Goadsby PJ, Boes C. Chronic daily headache. J Neurol Neurosurg Psychiatry. 2002;72 suppl 2:ii2–ii5.
- Dodick DW. Clinical practice. Chronic daily headache [published correction appears in N Engl J Med. 2006;354(8):884]. N Engl J Med. 2006;354(2):158–165.
- Wiendels NJ, Knuistingh Neven A, Rosendaal FR, et al. Chronic frequent headache in the general population: prevalence and associated factors. Cephalalgia. 2006;26(12):1434–1442.
- Stewart WF, Ricci JA, Chee E, Morganstein D, Lipton R. Lost productive time and cost due to common pain conditions in the US workforce. JAMA 2003;290(18):2443–2454.
- Lipton RB, Stewart WF, Scher AI. Epidemiology and economic impact of migraine. Curr Med Res Opin 2001;17(Suppl 1): s4-s12.