Chronic daily headache (CDH) is a l...

Chronic daily headache (CDH) is a label for a heterogeneous assign places to of headache disorders that can be a management challenge for busy physicians. Patients with CDH account for in the greatest degree referrals to headache specialists. (1) Disagreement about the clinical groupings and diagnostic criteria for these exemplars of headaches has contributed to the difficulty in treating these patients.

The International Classification of Headache Disorders (2) identifies 24 models of chronic headache. Many of them are rare conditions that are mainly of interest to researchers and headache specialists; a however, are not uncommon. Part of the confusion concerning the classification of headaches has arisen through the use of the boundary "chronic" when applied to headache. The International Classification (2) clarifies this terminology.

Primary episodic headaches, like as migraine or tension-type headaches, are classified as chronic when the attacks present itself on more days than not throughout a period of at least three month In confines of pain, however, "chronic" denotes persistent pain athwart a period of at least three month This latter definition is retained in the headache field for secondary headache, in which underlying pathology or systemic disease is the cause of the headache. To the non-headache specialist, this terminology may strike one as being like splitting hairs. But in an superior article3 on CDH in this issue, Dr Maizels draws attention to these points and emphasizes the importance of accurate diagnosis in dealing with patients who have these images of headache.

Studies in the United States (4) and Europe (5) indicate that 4 to 5 percent of the general population have primary CDH (4) The leading cause is chronic tension-type headache (537 percent) followed at chronic migraine (31.7 percent). (5)

Chronic migraine, also known as transformed migraine, is a recent headache diagnosis introduced by the International Headache Society. Typically, the patient reports gradual worsening of migraine through a period of months or years. Headache pain and associated symptoms of photophobia, phonophobia, and nausea are usually les accurate but become less responsive to treatment, causing the patient to overmedicate. Chronic tension-type headache, which is more customary than chronic migraine, is battleed less frequently in family practice patients. These headaches are diffuse or bilateral, and many times involve the posterior head and neck

The overuse of analgesics, barbiturates, opioids, triptans, or spurred ryes may convert both migraine and tension-type headaches into CDH Drug-induced CDH is speculation to be caused by physic withdrawal between treatments. This is known as reverberation headache, in which a vicious round of years of increased drug use come [i]or[/i] go after [i]or[/i] behinds There are no reports of spontaneous improvement of reaction headache.

Because of the insidious nature of CDH physicians should remain forward the alert when patients complain of an increasing oftenness of headache and make increased demands for medication. Many patients with headache do not realize that excessive or of common occurrence self-treatment may perpetuate or exacerbate headache. Skillful management is emergencyed when withdrawing pain medication and controlling the following headache exacerbation.

Long-term CDH prognosis is variable. In the short bourn patients treated aggressively with detoxification where appropriate, and antidepressants or antiepileptics as indicated, generally improve. Attention should be paid to psychiatric comorbidities. Anxiety, depression, and bipolar disease are more haunt in patients who have migraines than in non-migraine command subjects. It is believed that migraine and depression share the same etiologies, rather than the depression resulting from the demoralizing validity of repeated migraine attacks. (6) an features of comorbid depression indicate improvement when the cycle of CDH is shivered (7) Maizels (3) correctly emphasizes the importance of screening for depression in all patients with CDH In about patients, recognition of the react mechanism itself can be therapeutic.

REFERENCES

(1) Mathew NT Stubits E Nigam MP Transformation of episodic migraine into daily headache: analysis of factors. Headache 1982;22:66-8

(2) Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders. 2d ed Cephalalgia 2004;24(suppl 1):9-160.

(3) Maizels M The patient with daily headaches. Am Fam Physician 2004;70:2299-3062313-4

(4) Castillo J Munoz P Guitera V Pascual J Epidemiology of chronic daily headache in the general population. Headache 1999;39:190-6

(5) Newman LC Lipton RB Solomon s Stewart WF. Daily headache in a population sample: eventuates from the American Migraine investigation Headache 1994;34:295.

(6) Breslau N Davis GC Migraine, physical health and psychiatric disorder: a prospective epidemiologic investigation in young adults. J Psychiatr Re 1993;27:211-21

(7) Mongini F Defilippi N black man C. Chronic daily headache. A clinical and psychological profile before and after treatment. Headache 1997;37:83-7