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].

• Disability

  In 2008, the cohort was re-interviewed by physicians via telephone to determine the headache profile for the past year, including Migraine Disability Assessment (MIDAS), a headache disability questionnaire. [ncbi.nlm.nih.gov]

  Not only is headache painful, but also disabling. In the Global Burden of Disease Study, updated in 2004, migraine on its own was found to account for 1.3% of years lost due to disability (YLD). [web.archive.org]

  Not only is headache painful, but it is also disabling. In the Global Burden of Disease Study, updated in 2013, migraine on its own was found to be the sixth highest cause worldwide of years lost due to disability (YLD). [who.int]

  Unfortunately, few patients choose to undergo this necessary step toward improving their condition and reducing their disability. [hopkinsmedicine.org]

• Pseudotumor

  […] etiologies: 50 (16.6%) with secondary headache, 22 (7.3%) with complicated migraine, 20 (6.6%) with posttraumatic headache, 13 (4.3%) with seizure-related headache, 11 (3.6%) with brain tumors, 10 (3.3%) with tension-type headache, and 4 (1.3%) with pseudotumor [ncbi.nlm.nih.gov]

  […] ventriculoperitoneal shunt malfunction (11.5%), and migraine (8.5%). 3 Serious causes of headache are reported in 4% to 6.9% of children and include subdural hematoma, epidural hematoma, proven ventriculoperitoneal shunt malfunction, brain abscess, pseudotumor [accessmedicine.mhmedical.com]

• Congestive Heart Failure

  […] block Other pain disorders, fibromyalgia, depression, anxiety, insomnia Serotonin and norepinephrine reuptake inhibitors (venlafaxine) Mania Depression, fibromyalgia Beta blockers Asthma, depression, Raynaud’s diabetes, congestive heart failure Hypertension [clevelandclinicmeded.com]

  L-arginine is used for heart and blood vessel conditions including congestive heart failure (CHF), chest pain, high blood pressure, high cholesterol, heart surgery, recovery after heart transplant, heart attack, and coronary artery disease. [medlineplus.gov]

  Vitamin D supplementation improves cytokine profiles in patients with congestive heart failure: a double-blind, randomized, placebo-controlled trial. Am J Clin Nutr 2006;83:754-9. [ PubMed abstract ] Autier P, Gandini S. [ods.od.nih.gov]

• Localized Pain

  ) localized pain, unspecified type - code to pain by site, such as: abdomen pain ( R10.- ) back pain ( M54.9 ) breast pain ( N64.4 ) chest pain ( R07.1- R07.9 ) ear pain ( H92.0- ) eye pain ( H57.1 ) headache ( R51 ) joint pain ( M25.5- ) limb pain [icd10data.com]

  Signs and symptoms Typical symptoms of migraine include the following: Throbbing or pulsatile headache, with moderate to severe pain that intensifies with movement or physical activity Unilateral and localized pain in the frontotemporal and ocular area [emedicine.com]

• Collapse

  […] fluid intake Insufficient exercise Prescription and/or over-the-counter pain relief medications or chronic health conditions Pregnancy and childbirth Bowel disorders and/or damage that require further medical investigation Prolapse - a sagging and/or collapsing [continence.org.au]

  He found my door open and me collapsed on the bathroom floor. I was sent to hospital where I had to be put on a drip I was so dehydrated. That was the first time, but it was to happen many times over the next decade. [dailymail.co.uk]

• Snoring

  People who snore on a regular basis are more likely to have headaches every day or nearly every day, research shows. [headaches.about.com]

  Factors Snoring CDH sufferers were almost three times as likely to be habitual (every day) snorers than the episodic headache comparison group. This did not appear to be due to the usual factors associated with snoring/sleep apnea (e.g. [migrainetrust.org]

  He is also the creator of the website http://www.ihatecpap.com which helps patients find comfortable and effective alternatives to treat sleep apnea and snoring. The NHLBI considers sleep apnea to be a Temporomandibular disorder. [thinkbetterlife.com]

  Talk to your doctor if you have sleep disturbances, such as snoring. Don't skip meals. Eat healthy meals at about the same times daily. Avoid food or drinks, such as those containing caffeine, that seem to trigger headaches. [mayoclinic.org]

• Nausea

  There may be photophobia, phonophobia or mild nausea. [migrainerelief.com]

  […] neither moderate or severe nausea nor vomiting Not attributed to another disorder Table 3 New International Headache Society Criteria for Chronic Tension-Type Headache * 2.2 Diagnostic criteria: Headache occurring on ≥15 days per month on average for [jaoa.org]

  If nausea or vomiting are issues, you may be prescribed anti-nausea medication such as Zofran. All of these can have side-effects too, so we would recommend natural chiropractic care. [web.archive.org]

  If nausea or vomiting are issues, you may be prescribed anti-nausea medication such as Zofran. All of these can have side-effects too that you need to be aware of. Chiropractic care may an effective solution for you. [neurobalancechiropractic.com.au]

  The pain was pulsatile in 79%, 63.5% had nausea with or without vomiting, and 59.5% had photophobia and phonophobia. [ncbi.nlm.nih.gov]

• Vomiting

  The pain was pulsatile in 79%, 63.5% had nausea with or without vomiting, and 59.5% had photophobia and phonophobia. [ncbi.nlm.nih.gov]

  […] nonpulsating) quality mild or moderate intensity not aggravated by routine physical activity such as walking or climbing stairs Both of the following: no more than one of photophobia, phonophobia, or mild nausea neither moderate or severe nausea nor vomiting [jaoa.org]

  Tension-type headaches are usually not associated with other symptoms, such as nausea or vomiting. Some people may experience sensitivity to light or sound with the headache, but not both. [web.archive.org]

  Your body may lose a lot of fluid from: Sweating too much, for example, from exercising in hot weather Fever Vomiting or diarrhea Urinating too much (uncontrolled diabetes or some medications, like diuretics, can cause you to urinate a lot) You might [medlineplus.gov]

• Bruxism

  Bruxism is grinding your teeth at night, while TMJ affects the joints, located just in front of your ear, which connect the jaw to the skull. [health.com]

• Hypotension

  Headaches that can occur on a daily or near daily basis include: Cluster Hemicrania continua Idiopathic intracranial hypotension Migraine Tension-type Mixture of types (most commonly migraine and tension) While tension-type headaches are the most common [hopkinsmedicine.org]

  Hypotension may become a problem with this combination, however. Selective serotonin reuptake inhibitors (SSRI's), such as sertraline (Zoloft), paroxetine (Paxil), or fluoxetine (Prozac). [chicagoheadacheclinic.com]

  Other organic causes of thunderclap headache are colloid cyst of the third ventricle, CSF hypotension and acute sinusitis (particularly with barotrauma). [ 2 ] Hypnic headache : this is a dull headache that wakens the patient from sleep, occurs on at [patient.info]

• Heart Failure

  When your heart has to work harder, this can lead to several conditions: irregular heartbeats called arrhythmias, a heart murmur, an enlarged heart, or even heart failure. [nhlbi.nih.gov]

  L-arginine is used for heart and blood vessel conditions including congestive heart failure (CHF), chest pain, high blood pressure, high cholesterol, heart surgery, recovery after heart transplant, heart attack, and coronary artery disease. [medlineplus.gov]

  […] block Other pain disorders, fibromyalgia, depression, anxiety, insomnia Serotonin and norepinephrine reuptake inhibitors (venlafaxine) Mania Depression, fibromyalgia Beta blockers Asthma, depression, Raynaud’s diabetes, congestive heart failure Hypertension [clevelandclinicmeded.com]

  Severe pneumonia should be differentiated from acute heart failure. Pulmonary infiltrates that resolved after giving mechanical ventilation should point to heart failure and atelectasis rather than pneumonia. [en.wikipedia.org]

• Tachycardia

  Beta-blockers are very useful in combination with the tricyclics, as they help the headaches, and offset the tachycardia of the tricyclics. Hypotension may become a problem with this combination, however. [chicagoheadacheclinic.com]

  […] or glittering zigzag border Physical findings during a migraine headache may include the following: Cranial/cervical muscle tenderness Horner syndrome (ie, relative miosis with 1–2 mm of ptosis on the same side as the headache) Conjunctival injection Tachycardia [emedicine.com]

• Flushing

  Important side effects of niacin include flushing, nausea and fainting. [ncbi.nlm.nih.gov]

  Field testing of the novel associated features in criterion C1 for 3.1 Cluster headache, facial flushing and aural fullness, revealed that they did not add to diagnostic discrimination. [ihs-classification.org]

• Skin Rash

  Symptoms of high exposures to inorganic mercury include: skin rashes and dermatitis, mood swings, memory loss, mental disturbances, and muscle weakness. [epa.gov]

  PubMed Citation (Among 24 patients with Friedreich ataxia treated with resveratrol [1 g vs 5 g daily] for 12 weeks, adverse events more frequent with the higher dose included diarrhea [71% vs 8%], nausea [36% vs 8%] and skin rash [29% vs none], and 1 [livertox.nlm.nih.gov]

  PubMed Citation (25 year old man taking ~350,000 IU of vitamin A daily for two months presented with fatigue, skin rash, desquamation, alopecia and hepatomegaly [bilirubin 1.6 mg/dL, Alk P 1.5 times ULN], with rapid improvement on stopping vitamins). [livertox.nih.gov]

• Eruptions

  It can be found in spring water and is released when volcanoes erupt, trees are cut down, or fossil fuels and products made from them such as oil, gasoline, and natural gas are burned. [toxtown.nlm.nih.gov]

• Erythema

  Consequently the infection often presents itself by the presence of a “bulls-eye” rash called erythema migrans (EM) within 3–30 days post infection [11]. [ncbi.nlm.nih.gov]

• Photophobia

  The pain was pulsatile in 79%, 63.5% had nausea with or without vomiting, and 59.5% had photophobia and phonophobia. [ncbi.nlm.nih.gov]

  […] two of the following characteristics: bilateral location pressing/tightening (nonpulsating) quality mild or moderate intensity not aggravated by routine physical activity such as walking or climbing stairs Both of the following: no more than one of photophobia [jaoa.org]

  These criteria require the absence of nausea; if photophobia or phonophobia is present, the other must be absent ( Table 1 ). [doi.org]

  Both of the following No more than one of photophobia or phonophobia or mild nausea Neither moderate or severe nausea nor vomiting E. [migraine.ie]

  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. [symptoma.com]

• Blepharoptosis

  Compared with placebo, botulinum toxin A was associated with a greater frequency of blepharoptosis (drooping of the upper eyelid), skin tightness, paresthesias (a prickly, tingling sensation), neck stiffness, muscle weakness, and neck pain. [media.jamanetwork.com]

• Fear

  Using cognitive therapy approaches, people learn to “challenge” their fears, substituting more rational thoughts and accurately interpreting perceived danger signals. [headache-help.org]

  Eliminate the Case of Headache Pain with EarthCalm But fear not—the good news about this common cause of headaches is that you can get EMF protection and eliminate the hazards of EMF exposure. [earthcalm.com]

  If patients with headache are not thoroughly examined they are likely to feel that their worst fears have not been considered or excluded. [patient.info]

• Episodic Headache

  In that study, which also compared people with chronic daily headache to people with less-frequent episodic headache, found more than two-thirds of those with chronic daily headache reported insomnia, compared with about 39% of those with episodic headache [headaches.about.com]

  Patients with episodic headaches, such as migraines with interval-free periods, and patients with chronic daily headaches with very few headache-free days, are often evaluated and treated differently from each other. [ncbi.nlm.nih.gov]

  episodic headache (defined as 2-104 headache days per year). [migrainetrust.org]

  […] in the past year and less than 5 days of headache per month; intermediate frequency episodic headaches (IFEH) from 5-9 headaches per month; high frequency episodic headaches (HFEH) from 10-14 days of headache per month; [5] CDH. [scielo.br]

  Within two months (and frequently sooner), the chronic headache pattern will revert back to the earlier episodic headache pattern or will remit. [americanmigrainefoundation.org]

• 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]

• Aura

  The results were compared with 12 age-matched typical migraineurs, with and without aura, who had a history of migraine attacks occurring at intervals of 1 month or longer. [ncbi.nlm.nih.gov]

  […] of the aura. [doi.org]

  In migraine headaches, the headache pain usually starts within an hour of the auras. In some people, the auras occur without the headache. Migraine auras, whether associated with headache or not, are simply visual disturbances. [neurobalancechiropractic.com.au]

• Stroke

  Taurine reduced the annual relapse rate of stroke-like episodes from 2.22 to 0.72 (P=0.001). [doi.org]

  Headache: Is It a Stroke? When the circulation of blood and oxygen to the brain is interrupted (for various reasons), a stroke occurs. [everydayhealth.com]

  MedlinePlus: Headache Information related to headache and links to additional resources from the National Institute of Neurological Disorders and Stroke. [curlie.org]

  […] 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 [symptoma.com]

• 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]

• Trigeminal Neuralgia

  Trigeminal neuralgia Trigeminal neuralgia (TN) is a condition that causes pain in the face and head. The pain is usually on one side of the face. The pain is related to the trigeminal nerve, which runs from the brain to the side of the face. [instituteforchronicpain.org]

  The following year she developed another mononeuropathy—left maxillary trigeminal neuralgia. Case 2 A woman aged 37 with a 14-year history of uncomplicated type 1 diabetes mellitus developed severe left-sided occipito-parietal headaches. [ncbi.nlm.nih.gov]

  ) trigeminal neuralgia ( G50.0 ) G44 ) trigeminal neuralgia ( ICD-10-CM Diagnosis Code G50.0 Trigeminal neuralgia 2016 2017 2018 2019 Billable/Specific Code Applicable To Syndrome of paroxysmal facial pain Tic douloureux G50.0 ) The following code [icd10data.com]

  In 2012, Stidd had two patients with trigeminal neuralgia respond well to combined SONS and infraorbital nerve stimulation (IONS) [ 27 ]. [doi.org]

  A ► Anti headache drugs ‎ (3 F) C ► Cluster headache ‎ (1 C, 13 F) H ► Headaches in ancient Egypt ‎ (2 F) I ► Ice-cream headache ‎ (2 F) M ► Migraine ‎ (2 C, 1 P, 34 F) T ► Tension headache ‎ (4 F) ► Trigeminal neuralgia ‎ (2 F) File nella categoria " [commons.wikimedia.org]

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].

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]

Before the treatment, Pediatric Migraine Disability Assesment (PEDMIDAS) scores and grades of the patients were determined. Topiramate was given as 1 mg/kg/day then the dose was increased to 2 mg/kg/day at the tenth day of the treatment. [go.gale.com]

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]

In these trials both groups had fewer headaches than before treatment, but there was no difference between the effects of the two treatments. [dx.doi.org]

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]

Patient education Prognosis Even with optimal therapy, about one third of those who improve will have return of their daily headache and medication overuse pattern. [migraines.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]

Evaluation of red flags is important as they suggest a secondary etiology for a headache. [symptoma.com]

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 [accessmedicine.mhmedical.com]

Table 159-1 Etiology of Headache View Large | Save Table Table 159-1 Etiology of Headache Critical Secondary Causes Reversible Secondary Causes Vascular conditions Non–central nervous system infections Subarachnoid hemorrhage Focal Intraparenchymal hemorrhage [web.archive.org]

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]

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]

Carnitine is used by mitochondria for fatty acid transportation; its deficiency, however, has not been implicated in migraine pathophysiology. [ncbi.nlm.nih.gov]

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. [doi.org]

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]

Medications There are several reasons to consider daily medication to prevent migraines should. [clevelandclinicmeded.com]

Low doses of migraine-preventing medicines, such as beta blockers, may also be helpful as preventers of these headaches, and if these are not successful then specialist intervention is required for more complex medication to prevent and relive this condition [pharmacyplace.co.nz]

Many were put on preventive migraine medications and received vitamin supplementation, if levels were low. Because few received vitamins alone, the researchers were unable to determine vitamin effectiveness in preventing migraines. [sciencedaily.com]

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2. Matharu MS, Goadsby PJ. Trigeminal autonomic cephalgias. J Neurol Neurosurg Psychiatry. 2002;72 suppl 2:ii19–ii26.
3. 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.
4. Goadsby PJ, Boes C. Chronic daily headache. J Neurol Neurosurg Psychiatry. 2002;72 suppl 2:ii2–ii5.
5. 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.
6. 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.
7. 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.
8. Lipton RB, Stewart WF, Scher AI. Epidemiology and economic impact of migraine. Curr Med Res Opin 2001;17(Suppl 1): s4-s12.