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Why Do I Have A Headache Every Single Day?: All About Chronic Daily Headache
By: R. Allan Purdy, MD
Neurologists and headache experts like to classify things, and when it comes to headache there is a lot to classify. Headache can be a symptom of many different diseases and disorders, in addition to being a disorder itself. All told, there are over 300 types and causes of headache identified! That is a much longer list of possible diagnoses to be considered than exist for most diseases or disorders in the many areas of medicine.
When the International Headache Society (IHS) published its classification of headache disorders in 1988 it was 96 pages long, with 15 pages on migraine alone! While some chronic headache subtypes were included, such as chronic cluster headache and chronic tension-type headache, the concept of "chronic daily headache" was left out.
In retrospect, this omission was most interesting, since chronic daily headache is not an unusual condition in medical clinics. In fact, it’s one of the most common complaints seen by headache specialists.
Chronic daily headache is generally accepted to refer to a broad group of headache disorders that are daily or near daily, persistent and continuous for the most part. Chronic daily headache patients have headaches for more than 15 days per month or 180 days per year.
The great majority of these daily or near-daily headaches turn out to be "benign"—that is, they do not indicate the presence of a serious underlying disease, such as a brain tumor. However, it is important to seek medical attention to rule out any rare but potentially life-threatening disorders. Just as important, the benign types of chronic daily headache can often be effectively managed with good medical care.
The two most common types of chronic daily headache are chronic tension-type headache and transformed migraine. Recent studies suggest that about 4% of the general population have chronic daily headaches. Between 40%-60% of patients seeking treatment from headache centers have daily or near-daily headache, that is, chronic daily headache. Some of these patients have chronic tension-type headache but the majority have transformed migraine. Often these headaches are associated with overuse of medications.
Chronic Tension-Type Headache or Transformed Migraine?Nearly everyone can relate to the concept of episodic tension-type headache, as most headache sufferers have had these from time to time. The pain is usually mild to moderate in severity and it may have a pressing or tightening quality. The headache is felt on both sides of the head and is not worsened by activity. There is no vomiting but loss of appetite or light or sound sensitivity may occur. Chronic tension-type headache is defined as headaches following this pattern that occur at least 15 days per month for 6 months.
People with chronic tension-type headache may have no history of distinct migraine. They frequently use excessive amounts of painkillers or analgesics, and they may have symptoms of depression. They may have a history of episodic tension-type headache that evolved into the more frequent pattern.
Patients with transformed migraine have a history of migraine attacks, with or without aura, when they were younger, and over several years the migraine attacks become more frequent.
Soon the migraine characteristics give way to chronic daily headache with a daily or near-daily background headache that often resembles a typical "tension-type headache." Many still have some headaches that resemble those of their prior migraine attacks, although some will not.
In essence, the background "tension-type headache" probably is "mild migraine" for lack of a better word. It "behaves" like tension-type headache but probably is not biologically. You could say that patients with transformed migraine have "chronic migraine," but this concept is not universally accepted.
Many migraine patients will recognize the pattern of transformed migraine in their life history of migraine. They have a history of chronic daily headache but their history, unlike chronic tension-type headache, is on a background of migraine headache. Of course it is possible to have both patterns, but most people with chronic daily headache will have one or the other.
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