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Feature Article

Chronic daily headache: how to assess and manage

Darshan Ghia, Jacqui Saw

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Abstract

The two most common manifestations of chronic daily headache in general practice are chronic tension-type headache and chronic migraine. Secondary headache disorders and medication overuse should be excluded before giving lifestyle advice and planning prophylaxis and other treatment.

Key Points

  • Chronic daily headache is a collective term referring to several headache types including chronic migraine, chronic tension-type headache, new daily persistent headache and hemicrania continua.
  • When medication overuse is present, a separate diagnosis of medication-overuse headache should be considered.
  • In a large proportion of patients with chronic daily headache, the first management step after secondary causes of headache have been excluded is withdrawal of acute medication.
  • Lifestyle-related measures are critical in overall management and an interdisciplinary approach, managing neuropsychiatric disorders and other comorbid conditions, is essential.
  • Effective prophylactic pharmacological treatment reduces the need for acute medication use.

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