Chronic Daily Headache

Management of CDH

Treatment of medication overuse in patients with CDH requires tapering the short-acting “as needed” medication (e.g., at a rate of 10% a week to minimize withdrawal effects) and sometimes replacing this with a long-acting prophylactic drug. Headaches may increase in frequency or worsen during the tapering phase, but patients will adjust to a lower daily dose and ultimately, cessation of medication. Patients should receive education and continuous support during this medication withdrawal.

As with other persistent pain syndromes, successful of CDH requires a comprehensive approach that addresses psychosocial issues and comorbid conditions (e.g., depression, anxiety, sleep disorders). In addition, appropriate management of CDH will address any overuse of medications to treat the daily headaches. If a patient is taking daily medication in an effort to treat the headache, yet still has headache pain, it may be assumed that the medication is perpetuating the headache state. Effective management of CDH requires a partnership with the patient to develop a strategy of withdrawing from daily medications for acute attacks, to set goals for subsequent pain management and to provide patient education on the nature of chronic headaches.