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].

• Pain

  They also: Cause moderate pain but with spikes of severe pain Are daily and continuous with no pain-free periods May sometimes become severe with development of migraine-like symptoms Respond to the prescription pain reliever indomethacin (Indocin) Also [migrainerelief.com]

  Giovanni Cucchiaro, Pain in Children, Biobehavioral Approaches to Pain, 10.1007/978-0-387-78323-9_8, (149-194), (2008). Ann H. Johnson, Cathy Jordan and Claire M. [doi.org]

  […] of any nerve 784.0 Excludes Applies To Facial pain Pain in head NOS ICD-9-CM Volume 2 Index entries containing back-references to 784.0 : [icd9data.com]

  The pain may feel dull or squeezing, like a tight band or vice. Your shoulders, neck, or jaw may feel tight or sore. A migraine headache involves severe pain. [nlm.nih.gov]

• Inflammation

  The anti-inflammation and anti-infection functions for Vitamin D are newly identified and highly significant activities. [ncbi.nlm.nih.gov]

  Serrapeptase and Inflammation Serrapeptase is an enzyme that originally comes from the silkworm, now manufactured in a laboratory. It dissolves and digests inflammation within the body, causing it to easily break down. [serrapeptase.info]

  These medications include: Triptans Ergotamines Barbituates Non-steroidal anti-inflammatory drugs (NSAIDs) Conditions that may cause secondary chronic daily headaches include: Artery inflammation or spasm Venous clots Infections such as meningitis Abnormally [barrowneuro.org]

• Weakness

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

  Head pain with confusion, double vision, numbness, stiff neck, seizure, weakness or difficulty speaking. After a head injury. Worst headache even after medication and rest. [epainassist.com]

  Other symptoms are: Sudden weakness or numbness, especially on one side of the body. Sudden confusion. Sudden trouble speaking or understanding speech. Sudden difficulty seeing from one or both eyes. [everydayhealth.com]

  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]

  This can typically be recognized by overly clear, abundant urination; excessive water intake could cause mild dizziness, general weakness, and sometimes mild headaches. 2 Sleep Many Americans do not get adequate amounts of sleep each night because of [34-menopause-symptoms.com]

• Fatigue

  At this point, if he is not tired, the Pamelor may be pushed to as high as 150 mg, but he is fatigued on the 30 mg doses of Pamelor. [chicagoheadacheclinic.com]

  Both girls had a history of recurrent fatigue, muscle cramps, and multiple side effects from their prophylactic treatment. Carnitine levels were measured and found to be low. Carnitine supplementation was initiated. [ncbi.nlm.nih.gov]

  Excess fatigue, neck problems, and eyestrain can all cause extracranial headaches. Tension and chronic daily headaches Episodic tension headaches are by far the most common type of headache. [britannica.com]

  […] frequency and severity of his/her headaches: Drink plenty of fluid (4-8 glasses per day) Caffeine should be avoided Sports drinks may help during a headache as well as during exercise by keeping sugar and sodium levels normal Regular and sufficient sleep Fatigue [web.archive.org]

• Severe Pain

  They also: Cause moderate pain but with spikes of severe pain Are daily and continuous with no pain-free periods May sometimes become severe with development of migraine-like symptoms Respond to the prescription pain reliever indomethacin (Indocin) Also [migrainerelief.com]

  […] only one side of your head Are daily and continuous with no pain-free periods Cause moderate pain with spikes of severe pain Respond to the prescription pain reliever indomethacin (Indocin) Can become severe with development of migraine-like symptoms [mayoclinic.org]

  […] prescribed Rarely the pain becomes severe in people affected from migraine infection. [epainassist.com]

• Nasal Congestion

  The attacks are associated with one or more of the following, all of which are ipsilateral: conjunctival injection, lacrimation, nasal congestion, rhinorrhea, facial sweating, eyelid edema, and miosis. [icd9data.com]

  congestion or runny nose Drooping of the eyelid or constriction of the pupil Tearing or redness of the eye on the affected side [migrainerelief.com]

  congestion and/or rhinorrhea ptosis and/or miosis Complete response to therapeutic doses of indomethacin Not attributed to another disorder Table 5 New International Headache Society Criteria for Hemicrania Continua * 4.7 Hemicrania continua Diagnostic [jaoa.org]

  Nathan, The pathophysiology, clinical impact, and management of nasal congestion in allergic rhinitis, Clinical Therapeutics, 30, 4, (573), (2008). Ruud Heshof, Leo H. de Graaff, Juan J. Villaverde, Armando J.D. Silvestre, Thomas Haarmann, Trine K. [doi.org]

  […] or vomiting Daily, persistent headaches: Start suddenly and occur every day Involve tightening, pressing pain on both sides of head Include mild nausea or sensitivity to light and sound Hemicrania continua: Pain on one side of the face Runny nose or nasal [everydayhealth.com]

• Common Cold

  The most common type of headache seen in pediatric emergency rooms is headache caused by a cold (28.5%). [en.wikipedia.org]

  Prevention of the common cold. Female sexual problems. More evidence is needed to rate the effectiveness of L-arginine for these uses. L-arginine is converted in the body into a chemical called nitric oxide. [medlineplus.gov]

• 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]

• Constipation

  […] affects bladder control Constipation can cause accidential leakage from your bladder. [continence.org.au]

  Another retrospective study of 96 patients with primary headache also found comorbid constipation in 25%, but this was mostly associated with tension-type headaches[ 56 ]. [doi.org]

  Talk to your doctor if you are experiencing side effects such as a bad metallic taste, vomiting, diarrhea, constipation, or upset stomach. [nhlbi.nih.gov]

  Commonly Used Preventive Antimigraine Medications and Their Side Effects 37 Amitriptyline and nortriptyline Weight gain, dry mouth, sedation, constipation Atenolol Depression, fatigue, hypotension, bradycardia Botulinum neurotoxin type A Excessive weakness [neurotoxininstitute.com]

• Loss of Appetite

  This could be a fever, loss of appetite, or weight loss. It also stands for secondary risk factors, so if you have a headache in addition to HIV or cancer, call your doctor immediately. Neurologic symptoms. [everydayhealth.com]

  Along with the pain, people have other symptoms, such as sensitivity to light, noise, or smells; nausea or vomiting; loss of appetite; and upset stomach or belly pain. [webmd.com]

  Her food tasted like bile, causing loss of appetite and weight loss. This dysgeusia continued three weeks after her antibiotic was stopped. She had no smell problems but smell was not tested. [practicalneurology.com]

  During the third week of therapy, she developed fatigue, severe headaches, loss of appetite, weight loss, nausea and vomiting, thirst and pains in both legs. After the fourth week, she developed jaundice and was admitted for evaluation. [livertox.nih.gov]

• Hypertension

  (pseudotumor cerebri) Secondary Infectious Upper respiratory tract infection Sinusitis Meningitis Vascular Temporal arteritis Subarachnoid hemorrhage (SAH) Parenchymal hemorrhage Malignant hypertension Cavernous sinus thrombosis Space occupying lesions [accessmedicine.mhmedical.com]

  Common causes include: Aneurysm rupture and subarachnoid hemorrhage Brain tumor Encephalitis irritation and swelling, or inflammation, of the brain) Head injury Hydrocephalus (increased fluid around the brain) Hypertensive brain hemorrhage (bleeding in [medlineplus.gov]

  Hypertension, hypercholesterolemia, insulin resistance, stroke or coronary artery disease are comorbidities that periodontal disease and migraine could share. [ncbi.nlm.nih.gov]

• Dental Caries

  Arginine has also been used for dental caries and dental hypersensitivity. [medlineplus.gov]

• Back Pain

  I never had a headache until I reached 82 and started to think I had back pain from aging. I read Dr. Sarno and learned the back pain wasn't structural but from TMS, worrying about one thing or another. [tmswiki.org]

  Tic douloureux G50.0 ) The following code(s) above R51 contain annotation back-references Annotation Back-References In this context, annotation back-references refer to codes that contain: Applicable To annotations, or Code Also annotations, or Code [icd10data.com]

  Other frequent symptoms include non-specific abdominal pain, back pain, neck pain, and diffuse muscle and joint pain. [gosh.nhs.uk]

  He had a bout of bad back pain a few years ago, so he understood much of my fear and frustration. If I hadn’t had him to talk with, I probably would’ve turned to a support group, either in person or online. Lighten your load. [health.harvard.edu]

• Blurred Vision

  If you have a persistent headache, blurred vision, changes in your level of alertness, nervous system problems, or seizures, seek medical help right away. [medlineplus.gov]

  These include: headaches blurred vision red skin – particularly in the face, hands and feet tiredness high blood pressure dizziness discomfort in the tummy confusion bleeding problems – such as nosebleeds and bruising gout – which can cause joint pain [nhs.uk]

  The aching may be accompanied by: blurred vision light-headedness nausea sensory disturbances known as auras Migraine is the second most common form of primary headache and can have a significant impact on the life of an individual. [medicalnewstoday.com]

  Red flags, which should alert the family physician to seek further investigation Headache exacerbated by coughing, sneezing or straining Headache provoked by postural change (stooping or bending) Headache associated with eye movement and blurred vision [racgp.org.au]

  Acute toxicity is caused by a single or a few repeated very high doses (generally >100 times the RDA), arising within days to weeks with a typical symptom complex of severe headache, nausea, vertigo, blurred vision, muscle aches and lack of coordination [livertox.nih.gov]

• Anxiety Disorder

  Headache - assessment Headache - assessment Last revised in October 2017 Summary Back to topHeadache - assessment: Summary Generalized anxiety disorder is multifactorial and includes environmental stressors, genetic factors, chronic illness, and substance [evidence.nhs.uk]

  Traditional headache medicine might still help those with mental disorders like depression and anxiety, though, according to one article. [empowher.com]

  NDPH, like other primary headaches, may be also linked to mental health conditions such as anxiety and panic disorders. In fact, a third of children with chronic headaches will have associated problems like anxiety disorders or depression. [gosh.nhs.uk]

  It's co-morbid with adverse life events, anxiety and depressive disorders, possibly with other psychiatric disorders, other pain syndromes and sleep disorders; all these conditions contribute to beginning and maintaining CDH [ 14 ]. [headache.imedpub.com]

  Comorbidity of depressive and anxiety disorders in chronic daily headache and its subtypes. Headache. 2000;40(10):818-23. [Abstract | Full text] Bussone G. Clinical considerations on chronic migraine, pharmacoresistance and refractoriness. [sydneynorthneurology.com.au]

• Distractibility

  Pleasant distractions are very helpful. Thanks Tammy, it's does help to hear other headache success stories. Walt, worrying definitely is a headache trigger for me. I'm working on lowering my anxiety level. [tmswiki.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]

• Seizure

  Primary care doctors may sometimes spot early symptoms of increased intracranial pressure such as headache, seizures, or other nervous system problems. [medlineplus.gov]

  Anti-seizure medications. 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]

  The remainder of the patients with headache had the following 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 [ncbi.nlm.nih.gov]

  Also, seek medical attention if you are experiencing a headache along with seizures, confusion or lose consciousness, head injury, stiff neck, fever, ear or eye pain, or if symptoms interfere with daily activities. [web.archive.org]

• Neuralgia

  Occipital neuralgia: another benign cause of 'thunderclap headache'. J Neurol Neurosurg Psychiatry 1992; 55 : 411 [ PMC free article ] [ PubMed ] [ Google Scholar ] 6. Chouret EE. The greater occipital neuralgia headache. [ncbi.nlm.nih.gov]

  […] placed leads as a novel therapeutic treatment for intractable occipital neuralgia [ 12 ••]. [doi.org]

  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]

  Wellcome L0000159.jpg 1 186 × 1 564; 992 KB Catarrh, neuralgia and headache no more! [commons.wikimedia.org]

  Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Cephalalgia 2004; 24(Suppl 1): 1-160. 2) Li D, Rozen TD. The clinical characteristics of new daily persistent headache. [jhsnet.org]

• Dizziness

  One morning she woke up with dizziness, headache, and facial pain. "I thought it was just my sinuses that hurt,” she says. “But it didn't get any better, and it was different from a sinus headache. [everydayhealth.com]

  These include: headaches blurred vision red skin – particularly in the face, hands and feet tiredness high blood pressure dizziness discomfort in the tummy confusion bleeding problems – such as nosebleeds and bruising gout – which can cause joint pain [nhs.uk]

  This can typically be recognized by overly clear, abundant urination; excessive water intake could cause mild dizziness, general weakness, and sometimes mild headaches. 2 Sleep Many Americans do not get adequate amounts of sleep each night because of [34-menopause-symptoms.com]

  […] dehydration: Thirst Dry or sticky mouth Not urinating much Darker yellow urine Dry, cool skin Headache Muscle cramps Signs of severe dehydration: Not urinating, or very dark yellow or amber-colored urine Dry, shriveled skin Irritability or confusion Dizziness [medlineplus.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 [web.archive.org]

  Headache disorders, characterized by recurrent headache, are among the most common disorders of the nervous system. [who.int]

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]

1. Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders: 2nd edition. Cephalalgia. 2004;24(suppl 1):9–160.
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.