A patient who has headaches as many days as not — at least 15 days per month — is said to have chronic daily headache (CDH). Not a specific type of headache, CDH is rather a descriptive term applied to any number of headache types. Headaches that can occur on a daily or near daily basis include:

• Cluster
• Hemicrania continua
• Idiopathic intracranial hypotension
• Migraine
• Tension-type
• Mixture of types (most commonly migraine and tension)

While tension-type headaches are the most common CDH, they are relatively mild and tolerable. The majority of CDH cases fall into one of two categories, both related to migraine.

Medication overuse headache (rebound) is a CDH caused by the patient’s use of pain relievers. While the condition is frustrating and disabling, it is potentially curable.

An extremely difficult to treat — and all too common — type of CDH is a transformed migraine. This is a migraine that over time becomes more and more frequent, blurring together until there is a 24-hour-a-day continuous background headache with occasional superimposed, more severe migraine symptoms. A transformed migraine headache acts more like a chronic pain syndrome than a migraine in terms of its poor response to typical migraine drugs. Some researchers believe that years of chronic, frequent migraines can cause permanent scarring or other changes in the brain, creating this type of intractable CDH that may not be curable. While there is not a “magic bullet” for such cases, many patients can be effectively managed with a variety of treatments to substantially reduce pain and disability.

Because out of control migraines can transform into a CDH that is difficult to treat, it is very important to establish a good preventive regimen as early in life as possible.

Over 90 percent of patients with CDH have coexisting psychiatric problems, most often anxiety or depression (or both). This makes an already challenging condition even harder to treat. In general, such patients will not improve without some sort of coexisting psychiatric care, counseling, biofeedback or the like. Unfortunately, few patients choose to undergo this necessary step toward improving their condition and reducing their disability.