When headaches occur more than 15 days in a month on average, the neurologist diagnoses a chronic daily headache.
Some experts include in this syndrome conditions such as cluster headaches, hemicranial headaches, mixed migraines and tension type headaches. Others like a more narrow definition and only use the label “chronic daily headache” for the headache that does not fit into another category, but is occurring almost daily.
Symptoms
Patients with these type of headache often have two different symptoms.
First, there is a lower grade throbbing headache and a pressure in the head.
Bright light and sounds may aggravate the headaches. With these there is no nausea or vomiting associated and they occur for a few hours or are constant with some waxing and waning.
Secondly, there is a severe headache that occurs 2 to 3 times per week or up to 3 times per month, which could start with a migraine aura.
There is often nausea and vomiting associated with these more severe type of headaches as well as hypersensitivity to sounds and lights. Other symptoms that can be present are dizziness, ringing in the ears and mental symptoms such as anxiety and depression. A complicating factor is that the patient has become accustomed to taking large amounts of headache relieving medications over the years, which unfortunately has a headache amplifying effect as each pill withdrawal can trigger a flare-up of the underlying chronic daily headache.
Chronic Daily Headache
Treatment
Unfortunately there is no easy solution to this complex problem. However, withdrawal from the medication to which the patient has developed a dependency will be often very beneficial (Ref.1, p. 2070) although this is only part of the solution. Treatment of any mood disorder with cognitive therapy and antidepressant medication might help as well. A close contact with only one treating physician is very helpful. A neurology referral from time to time to not overlook any other condition is also recommendable. Non drug methods such as autogenic training, a moderate exercise program, a low sugar diet (Ref. 2), and acupuncture treatments from time to time often help in combination.
References:
1. Goldman: Cecil Textbook of Medicine, 21st ed.,2000, W. B. Saunders Company
2. B. Sears: “The top 100 zone foods”. Regan Books, Harper Collins, 2001.
3. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 176.
4. Noble: Textbook of Primary Care Medicine, 3rd ed.,2001, Mosby, Inc.
5. Goroll: Primary Care Medicine, 4th ed.,2000, Lippincott Williams & Wilkins
6.Rosen: Emergency Medicine: Concepts and Clinical Practice, 4th ed., 1998, Mosby-Year Book, Inc.
7. Ruddy: Kelley’s Textbook of Rheumatology, 6th ed.,2001, W. B. Saunders Company
8. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.
9. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier
10. Suzanne Somers: “Breakthrough” Eight Steps to Wellness– Life-altering Secrets from Today’s Cutting-edge Doctors”, Crown Publishers, 2008
