CPD: The patient with daily headaches.

Abstract

The term "chronic daily headache" (CDH) describes a variety of headache types, of which chronic migraine is the most common. Daily headaches often are disabling and may be challenging to diagnose and treat. Medication overuse, or drug rebound headache, is the most treatable cause of refractory daily headache. A pathologic underlying cause should be considered in patients with recent-onset daily headache, a change from a previous headache pattern, or associated neurological or systemic symptoms. Treatment of CDH focuses on reduction of headache triggers and use of preventive medication, most commonly antidepressants, antiepileptic drugs, and beta blockers. Medication overuse must be treatedwith discontinuation of symptomatic medicines, a transitional therapy, and long-term prophylaxis. Anxiety and depression are common in patients with CDH and should be identified and treated. Although the condition is challenging, appropriate treatment of patients with CDH can bring about significant improvement in the patient's quality-of-life. SA Fam Pract 2005;47(10) (Reprinted with kind permission from the American Family Physician 2004;70:2299-306, 2313-4. Copyright © 2004 by the American Academy of Family Physicians.) Permission from the AAFP was granted to publish this article in the hardcopy only. Kindly refer to www.aafp.org or subscribe to the hardcopy of South African Family Practice.