chronic daily headache

Last reviewed 04/2021

  • 5% of North American and Western European populations have headache on at least 15 days a month for, on average, four or more hours a day
  • a chronic daily headache is not just tension-type headache, nor is it all just due to medication overuse
  • if a doctor gets a history of frequent headache they need to pursue its basis
  • clinician needs to be aware of features suggestive of sinister or secondary headache. These include (1):
      • pain of sudden onset
      • fever
      • marked change in pain character or timing
      • neck stiffness
      • pain associated with higher centre complaints
      • pain associated with neurological disturbance e.g. clumsiness or weakness
      • pain associated with local tenderness, such as of the temporal artery
    • if a positive diagnosis that the headache is benign cannot be made then patients with a headache that is of recent onset or with neurological signs require brain imaging with computed tomography or magnetic resonance imaging (1)

Reference:

  1. BMJ 2006 Jan 7;332(7532):25-9