Daily headaches
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Understanding Daily Headaches: Insights and Management
Chronic Daily Headache (CDH): Definition and Prevalence
Chronic daily headache (CDH) is a term used to describe headaches that occur on at least 15 days per month for a minimum of three months. This condition affects approximately 4-5% of the global population, making it a significant public health issue . CDH encompasses a variety of headache types, including chronic migraine, chronic tension-type headache, new daily persistent headache (NDPH), and hemicrania continua .
New Daily Persistent Headache (NDPH): Characteristics and Challenges
Phenotype and Epidemiology
New daily persistent headache (NDPH) is a subtype of CDH that begins abruptly and persists daily from onset. It is characterized by a chronic migraine phenotype in 67% of cases, but it is less likely to be associated with a family history of headaches and has fewer migrainous symptoms compared to chronic migraine. NDPH is considered a distinct disorder, although it shares some features with other chronic headaches.
Triggers and Pathophysiology
NDPH is thought to be a heterogeneous syndrome with various specific triggers, challenging the notion that it is a primary headache disorder. Identifying and removing specific triggers can lead to clinical improvement, although these triggers remain unknown for many patients. The pathophysiology of NDPH is not fully understood, necessitating further research to uncover underlying mechanisms and effective treatments.
Classification and Diagnostic Criteria
Subtypes of CDH
CDH can be classified into primary and secondary types. Primary CDH includes chronic migraine, chronic tension-type headache, NDPH, and hemicrania continua. Secondary CDH involves headaches due to medication overuse or other underlying conditions . Accurate classification is crucial for effective management, and recent revisions in diagnostic criteria have improved the classification process .
Diagnostic Approach
The first step in managing CDH is to rule out secondary causes through appropriate investigations, often involving imaging techniques like MRI, which is superior to CT in detecting certain conditions . Identifying the duration of headache episodes (greater or less than 4 hours) can also refine the differential diagnosis.
Treatment Strategies
Preventive and Abortive Therapies
Effective management of CDH involves reducing headache frequency through preventive treatments and limiting the use of abortive therapies to avoid medication-overuse headaches (MOH) . Common preventive medications include antidepressants, antiepileptic drugs, and beta blockers. Nonpharmacological approaches, such as lifestyle modifications and complementary therapies, also play a role in managing CDH.
Addressing Comorbidities
Anxiety and depression are common comorbidities in patients with CDH and should be identified and treated to improve overall outcomes. A comprehensive treatment plan that addresses both headache symptoms and associated psychological conditions can significantly enhance the quality of life for patients with CDH.
Conclusion
Daily headaches, particularly chronic daily headache and new daily persistent headache, present significant challenges in diagnosis and management. Understanding the various subtypes, identifying potential triggers, and employing a combination of preventive and abortive treatments are essential for effective management. Ongoing research is crucial to uncover the underlying pathophysiology and develop more targeted therapies for these debilitating conditions.
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