What is chronic daily headache? Information for patients Neurology

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1 What is chronic daily headache? Information for patients Neurology

2 What is chronic daily headache (CDH)? Chronic daily headache (CDH) is the term used when a person has a headache on 15 days a month or more, for at least 3 months. Is chronic daily headache a diagnosis? Chronic daily headache or CDH is not a diagnosis, it is just a descriptive term to describe these types of headache. How common is CDH? About 4% of the population suffer chronic daily headache, that is 1 in every 25 people. What causes CDH? There are many causes of CDH, they are generally categorised as: Primary headaches where headache is one part of a group of symptoms Secondary headaches where headache is caused by a disorder that can be identified The two most common causes of CDH seen in headache clinics are: A primary headache known as chronic migraine A secondary headache known as medication overuse headache page 2 of 8

3 What is chronic migraine? Chronic migraine is the term used to describe headaches which occur on at least 15 of days in the month, and where (without medication) at least 8 of those days the symptoms are those of a migraine. Migraine symptoms can include: Throbbing, worsened by movement Nausea Sensitivity to noise, light or smell Chronic migraine often starts as episodic migraine where attacks occur on less than 15 days per month but gradually become more frequent over time. Eventually, the gaps between headaches fill in with milder headaches, resulting in only a few days of the month, if any, where the head feels 'crystal clear'. Additional symptoms in chronic migraine are common and may include: Twitching around the eye(s) Feeling spaced out and dizzy Vertigo Concentration difficulties Altered mood and irritability page 3 of 8

4 What is medication overuse headache? For some patients, taking acute medication (such as painkillers) on a regular basis can lead to chronic daily headache. This may be the result of taking medication on 3-4 days a week over a period of a few months. This can either cause CDH, or prevent it from being treated. Common drugs considered to cause medication overuse headache include pain-killers such as the following (or in combination): Paracetamol Opiate based preparations Tramadol Codeine based preparations Dihydrocodeine Ergotamine Caffeine Triptans Sumatriptan Zolmitriptan Rizatriptan Naratriptan Almotriptan Eletriptan Frovatriptan Anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen probably produce the same problem, although some experts believe naproxen is less likely to do so. Studies have shown that up to 70% of people with CDH taking frequent medication to relieve headaches, can improve by just stopping the medication. In some cases the headaches can resolve altogether. page 4 of 8

5 How long does it take to improve after stopping medication? After stopping acute medication, there can be a period of time during which the headache seems worse this is known as 'rebound headache'. This usually settles down after a period of time (for some this may take a few days, for others this may be a few weeks). Headaches often become less frequent, less severe and more amenable to treatment, especially with preventive treatments. A period of at least 4 weeks off acute medication is recommended but it may take another few weeks for any improvement to become apparent. What happens if I still experience headache after stopping medication? Medication overuse can block the useful effects of headache prevention drugs. By stopping acute medication such as painkillers you can help to restore your bodies response to other medication such as preventative treatments. This is known as 'recovery of therapeutic responsiveness'. So even if your headaches do not stop altogether by stopping acute medication, cutting them out will allow other headache prevention treatments to be more effective. Why is the term chronic daily headache used? CDH is common in neurology clinics and a period of assessment often lasting weeks or several months is required while a number of diagnoses are being considered. The term CDH can therefore be used during this time without committing to a specific diagnosis but still acknowledging that a person is suffering from chronic and frequent headaches. The fact that there are a number of causes of CDH means that it is not always possible for your doctor to make a specific diagnosis when you are first seen. Usually your doctor will follow you up and try to make a page 5 of 8

6 specific diagnosis with help from your headache diary and sometimes other investigations if required. Are any investigations/tests required for chronic daily headache? As chronic daily headache has a number of causes, investigations are often performed but as most cases are due to chronic migraine or medication overuse headache the results of investigations are usually normal. Keeping a headache diary with the date of attacks, severity, duration and treatment used is often essential to be able to make the diagnosis. Your doctor can discuss investigations/tests with you if you have any questions or concerns. Can chronic daily headache be treated? Treatment of chronic daily headache takes time and patience on the part of both the patient and doctor. Treatment often involves withdrawal of frequent acute medication (such as painkillers) and following this, if required, the introduction of a preventive drug taken daily to try to stop attacks occurring. Preventative medication aims to ultimately prevent the attacks from occurring but in some cases a reduction in duration or severity of attacks is seen instead. There are a number of different preventive medications which can be used and different people respond differently to such medications. Our aim is to offer a preventive drug that you can tolerate and increase the dose to improve the headache without causing side effects. page 6 of 8

7 What is the outlook long-term? With patience and persistence following a plan of management, many patients do improve. Some patients despite the best effects of their doctor do not make significant improvements and in some cases the input of a pain management service may be considered. Where can I find more information on chronic daily headache? Unfortunately there is limited information available on chronic daily headache or chronic migraine, though the following sources of information provide further advice on migraine in general and medication overuse headache. Diagnosis and treatment for migraine: General information on migraine: Information and support/advocacy for migraine Information and support/advocacy for chronic migraine Comprehensive information about all aspects of headache and migraine. Some information/leaflets require membership or need to be purchased: page 7 of 8

8 This leaflet is a general guide on chronic daily headache if you have any other queries or concerns about your headache or medications then you can discuss them with your GP or your neurologist. Produced with support from Sheffield Hospitals Charity Working hard to fund improvements that make life better for patients and their families Please donate to help us do more Registered Charity No organdonation.nhs.uk Alternative formats may be available on request. Please Sheffield Teaching Hospitals NHS Foundation Trust 2015 Re-use of all or any part of this document is governed by copyright and the Re-use of Public Sector Information Regulations 2005 SI 2005 No Information on re-use can be obtained from the Information Governance Department, Sheffield Teaching Hospitals. PD8565-PIL3619 v1 Issue Date: December Review Date: December 2017

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