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.
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.
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.
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