Chronic Daily Headache Syndrome

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45 million Americans suffer from chronic recurring headaches.  There are 150 different diagnostic headache categories.  Headache is one of the most challenging pain syndromes that face physicians today.

The Chronic Daily Headache Syndrome (CDHS) is defined as a recurring headache of unknown cause that occurs at least 15 days of the month over 3 successive months. There is no identifiable cause after a proper work-up.




Migraine Headache

What Are The Major Causes Of Chronic Headaches?

As I said before, there are 150 different diagnostic classifications of headaches. In the image below/on the right I have depicted the major types of headaches:

In CDHS the headache may not fit any classical description of one type of headache. In fact, you may have overlapping characteristics of multiple different types of headaches in one person.  It may also change from episode to episode (which can be very unnerving to both Doctor and person alike).

headache of causes

How Does a Headache Occur?

It used to be taught that migraine headaches were vascular in origin where the blood vessels first narrow..then reflexively engorge with blood causing pain from stretching of the blood vessels.

Tension headaches, we were taught in medical school, result from a contraction of the muscles of the head and neck. This puts tension on the scalp which causes pain.  




Sinus headaches occurred when the sinuses “filled up” with mucous and caused pain by pressure.  

We didn’t know what the mechanism of cluster headaches was.

Today we understand that the mechanisms of headache generation are very complicated.In fact, there are usually overlapping mechanisms causing the pain in any given headache sufferer.  This made the usual, orderly, step-care approach to headache therapy more confusing.  I liked to take a pragmatic approach and individualize the therapy.

headache signs
type of headache
A Practical Approach To Relief

In the chronic daily headache syndrome the patient will have usually seen a multitude of Doctors and have tried many different therapies.  Here is one pragmatic (practical) approach:

  • First make sure that a thorough history, physical, and diagnostic work-up has been done.  There should have been a Neurologist’s consult and an MRI of the brain (with contrast).
  • Next, review all the therapies that “have not worked” as there may have been a breakdown in how the therapies were taken.  You don’t want to necessarily exclude a therapy that was not taken correctly.
  • Simultaneously begin therapies that will relieve pain immediately and begin more long term, slower to work therapies.  This will give the headache sufferer hope and relief.
  • Aim to transition over to therapies that can be taken long term with minimal adverse consequences.  You may end up on opiate therapy at first (before the slower to work medications “kick in”).  You can be weaned off your opiate therapy if the other slower to act therapies work. 
  • Don’t give up…you may need to try many different therapies before you see relief.
heahache history
Last Words

I have reviewed the Chronic Daily Headache Syndrome, suggested a strategy for evaluating the completeness of your previous work-up and therapies, and put forth a pragmatic approach for relief.

Relief is possible…don’t give up.