Chronic Daily Headache – Diagnosis and Management

If you’ve been having at least 15 headaches per month consecutively, for a period of three months or more, this condition is classified into Chronic Daily Headache. It is most commonly reported in patients who have Tension Headaches and Migraine. In this case, getting your headache type diagnosed from a physician is very important to rule out any underlying disease and begin an effective treatment.

1. Risk factors
2. Conditions leading to Chronic Daily Headache
3. Complications of Chronic Daily Headache
4. Diagnosis

1-Risk factors

• Several factors can be associated with Chronic Daily Headache:
• Anxiety and depression.
• Female sex.
• Overuse of caffeine.
• Overuse of headache medication, mainly over the counter analgesics.
• Other chronic conditions such as sinusitis, migraine.
• Sleep disturbance.
• Obesity.

For each type of headache, there can be different predisposing risk factors.

2-Conditions leading to Chronic Daily Headache

Chronic Migraine

People who have frequent migraine attacks and take medication for it on a regular basis tend to develop Chronic Migraines.

Symptoms:

• Pulsating, throbbing pain.
• Nausea and vomiting.
• Sensitivity to light and sound.
• Migraine with Auras.

Management:

To manage the symptoms and preventing it from developing into a chronic condition, proper diagnosis should be made.

• Prophylactic treatment can be opted for, to avoid taking over the counter analgesics, once the episode begins.
• Lifestyle changes can be made i.e. healthy eating habits, a proper sleep schedule and weight loss can help.
• Risk factors should be identified and preventive measures can be taken to avoid the occurrence of a migraine attack.

Chronic Tension Headache

Tension Headache usually occurs as a result of bad posture, anxiety, depression, and fatigue from long working hours. This is usually experienced in the form of a tight band around the head.

Management:

• Treating the cause can help with the symptoms.
• Improving posture.
• Taking antidepressants or antipsychotics for anxiety and depression.
• Making some changes in lifestyle.

Hemicrania Continua

This is a primary headache disorder. People with hemicrania continua have reported it lasting for at least three months with three to five attacks per day.

Management:

Indomethacin is the most commonly prescribed drug for Hemicrania Continua. Most patients have reported relief within 24 hours. While for others it took two to five days.

New Daily Persistent Headache (NPDH)

It is a headache syndrome that involves continuous headache for 3 days with no pain-free episode during this duration. The headache is usually unremitting.

Management:

• Triptans, Muscle relaxants, and NSAIDS give relief.
• The headache is usually self-limiting so no treatment is required in most cases.

Trigeminal Autonomic Cephalgias (TAC)

This is a primary headache disorder with additional autonomic signs related to the Trigeminal nerve. These can be lacrimation, miosis, and rhinorrhea. Accompanied by several cluster attacks. The main cause of development and progression of TAC is its delayed diagnosis.

The pathophysiology involves Circadian rhythms of the body.

Management:

• Indomethacin is used to treat TACs.
• Inhalation of 100% oxygen can also help with the cluster attacks.

Some other causes of Chronic Daily Headaches can be

• Inflammation in the blood vessels of the brain (Arteritis)
• Traumatic Brain Injury
• Increased Intracranial pressure or decreased Intracranial pressure
• Brain tumor
• Infection of meninges
• Stroke or concussion

3-Complications of Chronic Daily Headache

Medication Overuse Headache (MOH)

Taking painkillers on a daily basis might lead to the development of rebound headaches. The most frequently consumed analgesics recorded are codeine (and other opium containing preparations) and triptans. Patients who consume analgesics, more than 10 to 15 days per month report with MOH.

Treatment:

Prophylactics for the initial cause of the headache may help reduce the rebound headaches as they initially force the patient to take analgesic.

Withdrawal of the culprit analgesic can be the only possible management for MOH.

Renal Disease

A lot of painkillers are excreted through urine and their regular use may pose adverse effects to the normal kidney function.

Liver failure

Since the metabolism of drugs takes place in the liver, making it prone to damage and eventually failure.

Other complications are

• Sleep disturbance
• Depression
• Psychological symptoms
• The physical dependence on Opioids and Barbiturates can develop

 4-Diagnosis

• To make an accurate diagnosis and move on with proper treatment, certain questions are asked during history taking:
• An accurate number of days with headache in a month.
• The exact duration of each episode of headache with treatment and without treatment, both.
• Location, Severity, debilitation due to Pain.
• Any sort of associated symptoms such as Photophobia, Phonophobia, Nausea, or Neurological Symptoms.
• Depending on the symptoms, Physical examination of head and neck muscles along with Eye examination might be required.

FAQ