Chronic Daily Headache

Definition

Chronic daily headache (CDH) is not a formal diagnosis in the International Classification of Headache Disorders, 3rd edition (ICHD-3). Rather, it is an umbrella term used to describe a range of primary and secondary headache disorders characterized by duration and/or frequency depending on the specific headache type. For example, some long CDH subtypes (see below) must persist for 15 or more days per month for at least 3 months while shorter duration CDH subtypes- e.g., cluster or paroxysmal hemicrania- must persist for at least one year without remission or with remissions lasting less than three months.

So while not a distinct diagnosis itself, chronic daily headache encompasses a group of headache disorders marked by extremely frequent headache attacks.

Epidemiology

- CDH has an estimated worldwide prevalence of around 4% in adults. It is 2-3 times more common in females.

- The most common headache types underlying CDH are chronic tension-type headache and chronic migraine. CDH results in substantial disability and economic costs.

CDH Subtypes

The main CDH subtypes of long duration (≥4 hours per headache) are:

  - Chronic migraine: evolution from episodic migraines, migraine features on ≥ 8 days/month

  - Chronic tension-type headache: pressing, bilateral pain without migraine features

  - Medication overuse/adaptation headache: worsening headaches due to overuse of acute medications

  - Hemicrania continua: unilateral, moderate pain with cranial autonomic symptoms

  - New daily persistent headache: daily headaches without characteristic features

https://www.cerebraltorque.com/blogs/migrainescience/new-daily-persistent-headache-ndph

Other shorter duration headaches (<4 hours per headache) can also be chronic, like:

  - Chronic cluster headache

  - Chronic paroxysmal hemicrania

  - Short-lasting unilateral neuralgiform headache attacks

https://www.cerebraltorque.com/blogs/migrainescience/trigeminal-autonomic-cephalalgias

  - Hypnic headache

https://www.cerebraltorque.com/blogs/migrainescience/hypnic-headache

  - Primary stabbing headache

https://www.cerebraltorque.com/blogs/migrainescience/primary-stabbing-headache-aka-ice-pick-headache-symptoms-pathophysiology-diagnosis-and-treatment

Diagnosis

CDH diagnosis depends on meeting criteria for specific headache types after excluding secondary causes.

- Most patients have an unrevealing history and normal neurological exam.

- Further diagnostic testing is based on the presence of "red flags" like:

https://www.cerebraltorque.com/blogs/migrainescience/do-i-need-neuroimaging-for-my-headache

- Differential includes secondary headaches from infections, mass lesions, vascular disorders, etc. See link above for more information.

Treatment

Treatment focuses on the specific CDH diagnosis and preventing medication overuse/adaptation headache.

- Chronic migraine: preventives, avoidance of triggers, acute medications, assess for medication overuse/adaptation headache.

Acute: https://www.cerebraltorque.com/blogs/migrainescience/acute-migraine-treatment-cheat-sheet

Prevention: https://www.cerebraltorque.com/blogs/migrainescience/chronic-migraine-preventives

- Chronic tension-type headache: preventives, behavioral and physical therapy 

Acute: https://www.cerebraltorque.com/blogs/migrainescience/acute-treament-of-tension-type-headache-tth

Prevention: https://www.cerebraltorque.com/blogs/migrainescience/tension-type-headache-preventive-treatment

- Medication overuse/adaptation headache: Establish preventives

https://www.cerebraltorque.com/blogs/migrainescience/medication-overuse-headache-moh-treatment-has-changed-mots-medication-overuse-treatment-strategy-trial

- Other CDH subtypes have more specific treatments e.g. indomethacin for hemicrania continua

https://www.cerebraltorque.com/blogs/migrainescience/trigeminal-autonomic-cephalalgias