Chronic daily headache (CDH) is a very common type of headache. It occurs in 4-5% of the population, and is the leading problem seen in headache practices. In the United States, up to 80% of patients seen in headache clinics have chronic daily headache. As the name implies, CDH refers to headaches that are present very frequently, usually on more than 15 days per month. The subtypes are Chronic Migraine, Chronic Tension-Type Headache, New Daily Persistent Headache, Chronic Cluster Headache, Hemicrania Continua, Chronic Paroxysmal Hemicrania and Medication-Overuse Headache.
The most common cause of CDH is medication overuse. The regular use of caffeine-containing drugs (Excedrin, Anacin, Fioricet, Fiorinal, Esgic and other), barbiturates (Fiorinal, Fioricet, Esgic) and narcotics (Vicodin, Percocet, Tylenol with codeine, Oxycontin). Triptans, such as sumatriptan (Imitrex), rizatriptan (Maxalt) and other do not cause rebound or medication overuse headaches. Taking aspirin actually can reduce the chances of developing chronic migraine. Many patients with CDH report that though they initially had only occasional migraines, they began having persistent low-grade daily headaches as they increased their medication use. As the headache frequency increased, the acute medications (with caffeine, butalbital, or narcotics) seemed to become less and less effective. This happens because the acute medications are short-acting, and as the effect of one dose wears off a withdrawal syndrome occurs, triggering another headache and the need to take more medication. This pattern becomes a vicious cycle of daily headaches and frequent, albeit ineffective, medication intake. Furthermore, the overuse of acute medication makes the headaches refractory to treatment with preventative agents. The most effective way of preventing CDH is to limit the use of these medications to a total of 1 – 2 times per week. Again, even though many doctors believe that triptans, aspirin, ibuprofen and naproxen can also cause medication overuse headaches, there is no evidence to support this claim.
Other factors that have been associated with CDH include stressful life events, emotional abuse, obesity, head injury, excessive caffeine consumption, snoring, and low socioeconomic status.
Treatment of CDH depends on what subtype you have. Botox is an FDA-approved treatment for chronic migraines and it is highly effective and is safer than any medication taken by mouth. Medication overuse is treated by stopping overused medications. Getting Botox injections first may make this process easier. You will usually be given a triptan or another medicine to make withdrawal easier. It may take a month or longer before detoxification from the acute medication is complete and headaches improve. Patients who continue to have daily headaches despite stopping overused medications may require daily preventative medications. Non-drug therapy also plays a role in the treatment of CDH. Acupuncture, biofeedback, relaxation training and cognitive-behavioral therapy can be very effective, particularly when used in conjunction with medications. Two rare types of daily headache, chronic paroxysmal hemicrania and hemicrania continua are treated with indomethacin, which provides very dramatic relief. Magnesium, feverfew, coenzyme Q10 and other supplements can also help. We see many patients who obtain complete relief of their headaches after they receive an infusion of magnesium.