A synopsis of:
Chronic Daily Headache: Diagnosis and Management
JOSEPH R. YANCEY, MAJ, MC, USA, Fort Belvoir Community Hospital, Fort Belvoir, Virginia RICHARD SHERIDAN, CPT, MC, USA, 1/25 Stryker Brigade Combat Team, Fort Wainwright, Alaska KELLY G. KOREN, LT, MC, USN, Fort Belvoir Community Hospital, Fort Belvoir, Virginia Am Fam Physician. 2014 Apr 15;89(8):642-648.
A headache is considered chronic when it occurs for at least 15 days a month for 3 consecutive months. They are further classified by either long or short duration, depending on if each individual headache lasts for more, or less, than four hours. Risk factors include obesity, medications, stress, snoring, caffeine use, and chronic pain. Lab work is not helpful in the diagnosis. Important illnesses in the differential include intracranial hemorrhage, arnold-chiari malformation, subarachnoid hemorrhage, neoplasm, ICP, hemorrhagic stroke, meningitis, encephalitis, and GCA. MRI or CT can help when ruling out these red flags.
Short duration chronic daily headaches include brief headache syndromes and trigeminal autonomic cephalalgias. Brief headache syndromes include hypnic (during sleep), primary cough (from coughing or valsalva), primary emotional (pulsating pain from exertion), and primary stabbing (transient and localized). Trigeminal autonomic cephalalgias include chronic cluster headaches (stabbing pain behind the eye), paroxysmal hemicrania (severe unilateral orbital/ temporal pain), and SUNA/SUNCT (unilateral stabbing/ pulsating pain). Long duration chronic daily headaches include hemicrania continua (unilateral pain with injection, lacrimation, rhinorrhea, ptosis, or miosis), migraine, and tension (occipital or bandlike).
Treatment includes nonpharmacologic therapies including cessation of tobacco/caffeine, biofeedback, relaxation techniques, good sleep hygiene, diet, and regular mealtimes. Abortive therapies include acetaminophen, NSAIDs, tramadol, and triptans. Prophylactic therapies include amitriptyline, fluoxetine, gabapentin, onabotulinumtoxinA, propranolol, tizanidine, and valproate/ topiramate. Adverse affects from medications are common in these patients, especially due to overuse.
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