Chronic Daily Headache (CDH)
One of the conditions we treat on an ongoing basis at the Miami Headache Institute are chronic daily headaches, or CDH. This a term used to describe any headache that recurs almost daily. These can include chronic tension headaches, transformed migraines and chronic migraines.
CDH is most often applied to headaches, not related to illness, occurring at least 15 times a month. Chronic tension type headaches are daily or near daily headaches occurring in patients who have experienced episodic tension headaches in the past. Chronic tension type headaches tend to be bilateral or diffuse, often involving the back of the head and neck.
The experts at Miami Headache Institute have found that transformed migraine and chronic migraine sufferers are almost exclusively women. Most began experiencing migraines in young adulthood and usually have a family history of depression, panic disorders, or alcohol abuse. Eighty percent of transformed migraine patients suffer from depression, and the same percentage of chronic migraine patients overuse medication. The most common experience is of migraines that are more frequent over time developing into a daily, or near daily pattern.
Transformed and chronic migraines are similar to tension headaches and are not usually associated with neurological or gastrointestinal conditions. Transformed migraines can develop from overuse of medication but can also occur without it. Treatment of chronic daily headache must take into account the treatment of any associated psychiatric disorder, if present. Preventative treatments may be needed including calcium channel blockers, anticonvulsants, beta blockers and antidepressants, sometimes in combination. Non pharmacologic therapy can include behavioral psychotherapy and lifestyle changes.
Drug Overuse Can Increase Headache Pain Recurrence
Overuse of opiates, analgesics and ergot-amines can go hand in hand with chronic daily headache. Medication overuse can lead to what are called rebound headaches which can in turn lead to medication dependency. The most common history is of an episodic migraine converted to a transformed migraine through overuse of medication. Treatment of these types of headaches begins with discontinuing use of the offending drug and preparing for possible withdrawal symptoms. If the dependency is advanced, withdrawal is done gradually over a period of weeks.