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.  Though CDHs are divided into long-duration headaches (last longer than 4 hours) and short-duration headaches (last less than 4 hours), the majority of people who suffer from CDH have long-duration headaches.  If you have CDH, your doctor will determine your sub-type based on your headache location, severity and associated features.  Any prior headache history will be taken into account as well.  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) and to a lesser extent triptans, ergotamine, ibuprofen, acetaminophen, or narcotics, alone or in combination, more than 2-3 times per week can lead to CDH.   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 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 acute medications to a total of 2-3 times per week.

Other factors that have been associated with CDH include hypothyroidism, stressful life events, emotional abuse, head injury, excessive caffeine consumption, snoring, and low socioeconomic status.

Treatment of CDH depends on what subtype you have.  In general, the best way of treating CDH is to stop any overused medications.  Though doing so may result in a period of worsened headaches, you will be given a substitute medication to help you through this time.  In some cases you may be given additional short-term medication to prevent withdrawal symptoms.  It may take a month or so before detoxification from the acute medication is complete and headaches improve.  People who continue to have daily headaches despite stopping overused medications may require daily preventative medications or Botox injections.  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.  Magnesium, feverfew, coenzyme Q10 and other supplements can also provide significant relief.