The headache that never ends
Headache specialists use the term "chronic daily headache" (CDH) to refer to one of several types of headache disorders in which patients experience daily or near-daily headache pain. It is important to know that CDH is not a true diagnosis, but rather a descriptive term. It gives the doctor a starting place from which to determine precisely what headache disorder is the cause of such unrelenting pain.
Is there a known cause?
Generally, a headache specialist will rule out secondary headache disorders first. This involves getting an MRI of the head and maybe the neck. If abnormalities are found that appear likely to cause daily headache, then treatment recommendations will involve the correction or mitigation of these problems.
This happened to a family member who had no prior history of headache disorder. She suddenly started getting severe headaches every day that did not respond to even powerful narcotics. An MRI revealed a benign tumor at the base of her skull. Once the tumor was removed and she recovered from surgery, she no longer experienced headaches.
In the absence of a known cause, headache specialists will determine if the headaches have a short or long duration. Sometimes, headaches occur daily, but last for a relatively short period (< 4 hours). Others will drag on for many hours. These patients generally report constant low-level pain with periodic spikes in intensity.
Based on reader comments, many of you experience this type of headache disorder. You have tried many treatments with very little success. You may feel discouraged, hopeless, depressed, and even cynical about the possibility of relief. Unrelenting pain will do that to you. It eats away at your energy, robbing you of the will to fight. It can be tempting for you and your doctor to label your pain as chronic migraine. But that is only one of four possible explanations. A headache specialist will review your symptoms to determine which headache disorder you are actually experiencing.
If you are very fortunate, you might be experiencing the one type of chronic daily headache that usually responds to treatment. This type of daily headache is side-locked but may change sides on occasion. It varies in intensity, but never really goes away. Patients may have cluster headache-like symptoms such as a runny or stuffy nose, tearing of the eye, or eyelid drooping. Only the painful side is affected by these symptoms. The good news is that most patients respond to treatment with indomethacin. The bad news is that this drug has some significant side effects.
New Daily Persistent Headache
If you don’t have a family history of migraine and suddenly get a headache that never goes away, NDPH may be the culprit. These headaches usually lack the characteristic symptoms of nausea and sensitivity to light and sound associated with migraine.
Chronic Tension-Type Headache
Daily headaches that are not accompanied by stereotypical migraine symptoms such as nausea, light sensitivity, intolerance to sound, and aura may be diagnosed as chronic TTH. These headaches generally don’t respond to migraine-specific treatments such as triptans or ergotamines. The can feel like a tight band around the head and are usually not one-sided.
A lot of headache specialists still refer to this particular type of chronic migraine as “transformed migraine”. Most patients have a long history of episodic migraine with a gradual increase in frequency and severity until there is no longer a break between attacks. The vast majority of patients with CDH will be diagnosed with chronic migraine.
There is a world of difference between the patient experiencing 15 or 16 separate migraine attacks each month and a patient who never gets a break from the pain. Both receive a diagnosis of chronic migraine, but the clinical treatment is very different and the level of disability is dramatically worse for patients with unremitting pain.
Difficult to treat
Any one of these headache disorders can be difficult to treat. Quite often, patients with CDH will experience more than one type of headache disorder. The tremendous burden of CDH cannot be overstated. Most patients are unable to work or engage in family activities or even hobbies. Depression and anxiety are very common. Treatment generally involves a multidisciplinary approach, utilizing many different approaches. Medication, physical therapy, lifestyle coaching, mental health services, and even complementary or alternative medicine may all be necessary, depending on the severity of symptoms and the presence of comorbid conditions. It can take years to find the right combination of treatments.
Don't give up
If you are experiencing a type of chronic daily headache, please don't give up. Fight hard to find a specialist who really understands headache medicine. Your condition is the most difficult type of migraine to treat and you deserve the very best doctors to help you find relief. If your current doctor has run out of ideas or tells you there is nothing else to try, then it's time to find a new doctor with fresh ideas. No one in that much pain deserves a doctor who will give up on them.
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