Headache Occurring on More Days Than Not

  • Christina Sun-Edelstein
  • Alan Rapoport
Reference work entry


The term “chronic daily headache” (CDH) is commonly used to refer to primary headache that occurs on at least 15 days per month (more days than not). CDH is common, and associated with social, behavioral, and occupational disability. In recent years, the concept of disease modification has been applied to migraine, with an emphasis on the identification of factors that might prevent disease progression. The early recognition of high-risk patients and the utilization of a multidisciplinary treatment plan while headaches are still in the episodic phase appear to be critical aspects in preventing or minimizing progression and resultant disability. In this chapter, risk factors for CDH will be reviewed and principles of preventing headache chronification, including the initiation of preventive medication and behavioral treatment, the recognition of medication overuse, and the implementation of lifestyle modifications, will be discussed. Areas of ongoing research will also be addressed.


Chronic Migraine Chronic Daily Headache Medication Overuse Headache Frequency Episodic Migraine 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Andrasik F (2003) Behavioral treatment approaches to chronic headache. Neurol Sci 24(Suppl 2):S80–S85PubMedGoogle Scholar
  2. Andrasik F (2007) What does the evidence show? Efficacy of behavioural treatments for recurrent headaches in adults. Neurol Sci 28:S70–S77PubMedCrossRefGoogle Scholar
  3. Andrasik F, Blanchard EB, Neff DF, Rodichok LD (1984) Biofeedback and relaxation training for chronic headache: a controlled comparison of booster treatments and regular contacts for long-term maintenance. J Consult Clin Psychol 52:609–615PubMedCrossRefGoogle Scholar
  4. Andrasik F, Buse DC, Grazzi L (2009) Behavioral medicine for migraine and medication overuse headache. Curr Pain Headache Rep 13:241–248PubMedCrossRefGoogle Scholar
  5. Bahra A, Walsh M, Menon S et al (2003) Does chronic daily headache arise de novo in association with regular use of analgesic? Headache 43:179–180PubMedCrossRefGoogle Scholar
  6. Bigal ME, Ashina S, Burstein R et al (2008) Prevalence and characteristics of allodynia in headache sufferers: a population study. Neurology 70:1525–1533PubMedCrossRefGoogle Scholar
  7. Bigal ME, Rapoport AM, Sheftell FD, Tepper SJ, Lipton RB (2004) Transformed migraine and medication overuse in a tertiary headache centre- clinical characteristics and treatment outcomes. Cephalalgia 24:483–490PubMedCrossRefGoogle Scholar
  8. Bigal ME, Liberman JN, Lipton RB (2006) Obesity and migraine: a population study. Neurology 66:545–550PubMedCrossRefGoogle Scholar
  9. Bigal ME, Lipton RB (2006a) Obesity is a risk factor for transformed migraine but not chronic tension-type headache. Neurology 67:252–257PubMedCrossRefGoogle Scholar
  10. Bigal ME, Lipton RB (2006b) Modifiable risk factors for migraine progression (or for chronic daily headaches): clinical lessons. Headache 46(Suppl 3):S144–S146PubMedCrossRefGoogle Scholar
  11. Bigal ME, Lipton RB (2008a) Clinical course in migraine: conceptualizing migraine transformation. Neurology 71:848–855PubMedCrossRefGoogle Scholar
  12. Bigal ME, Lipton RB (2008b) The prognosis of migraine. Curr Opin Neurol 21:301–308PubMedCrossRefGoogle Scholar
  13. Bigal ME, Lipton RB (2008c) Excessive acute migraine medication use and migraine progression. Neurology 71:1821–1828PubMedCrossRefGoogle Scholar
  14. Bigal ME, Lipton RB (2009) What predicts the change from episodic to chronic migraine? Curr Opin Neurol 22:269–276PubMedCrossRefGoogle Scholar
  15. Blanchard EB (1992) Psychological treatment of benign headache disorders. J Consult Clin Psychol 60:537–551PubMedCrossRefGoogle Scholar
  16. Boardman HF, Thomas E, Millson DS, Croft PR (2005) Psychological, sleep, lifestyle, and comorbid associations with headache. Headache 45:657–669PubMedCrossRefGoogle Scholar
  17. Burstein R, Cutrer MF, Yarmitsky D (2000) The development of cutaneous allodynia during a migraine attack: clinical evidence for the sequential recruitment of spinal and supraspinal nociceptive neurons in migraine. Brain 123:1703–1709PubMedCrossRefGoogle Scholar
  18. Burstein R, Collins B, Jakubowski M (2004) Defeating migraine pain with triptans: a race against the development of cutaneous allodynia. Ann Neurol 55:19–26PubMedCrossRefGoogle Scholar
  19. Busch V, Gaul C (2008) Exercise in migraine therapy – is there any evidence for efficacy? A critical review. Headache 48:890–899PubMedCrossRefGoogle Scholar
  20. Calabresi P, Cupini LM (2005) Medication-overuse headache: similarities with drug addiction. Trends Pharmacol Sci 26:62–68PubMedCrossRefGoogle Scholar
  21. Calhoun AH, Ford S (2007) Behavioral sleep modification may revert transformed migraine to episodic migraine. Headache 47:1178–1183PubMedCrossRefGoogle Scholar
  22. Campbell JK, Penzien DB, Wall EM (2000) Evidence-based guidelines for migraine headaches: behavioral and physical treatments. Retrieved from Accessed 1 Feb 2010
  23. Castillo J, Munoz P, Giitera V, Pascual J (1999) Kaplan Award 1998: epidemiology of chronic daily headache in the general population. Headache 39:190–196PubMedCrossRefGoogle Scholar
  24. Chan PL, Holford NH (2001) Drug treatment effects on disease progression. Annu Rev Pharmacol Toxicol 41:625–659PubMedCrossRefGoogle Scholar
  25. Charles JA, Peterlin BL, Rapoport AM, Linder SL, Kabbouche MA, Sheftell FD (2009) Favorable outcome of early treatment of new onset child and adolescent migraine-implications for disease modification. J Headache Pain 10:227–233PubMedCrossRefGoogle Scholar
  26. Couch JR, Lipton RB, Stewart WF, Scher AI (2007) Head or neck injury increases the risk of chronic daily headache: a population-based study. Neurology 69:1169–1177PubMedCrossRefGoogle Scholar
  27. Cupini LM, Calabresi P (2005) Medication-overuse headache: pathophysiological insights. J Headache Pain 6:199–202PubMedCrossRefGoogle Scholar
  28. Dodick DW (2002) Debate: analgesic overuse is a cause, not consequence, of chronic daily headache analgesic overuse is not a cause of chronic daily headache. Headache 42:547–554PubMedCrossRefGoogle Scholar
  29. Dodick DW (2006) Chronic daily headache. N Engl J Med 354:158–165PubMedCrossRefGoogle Scholar
  30. Dodick DW, Silberstein SD (2007) Migraine prevention. Pract Neurol 7:383–393PubMedCrossRefGoogle Scholar
  31. Evans RW, Loder E, Biondi DM (2004) When can successful migraine prophylaxis be discontinued? Headache 44:1040–1042PubMedCrossRefGoogle Scholar
  32. Evers S, Afra J, Frese A et al (2009) EFNS guideline on the drug treatment of migraine-revised report of an EFNS task force. Eur J Neurol 16:968–981PubMedCrossRefGoogle Scholar
  33. Genazzani AR, Nappi G, Facchinetti F, Micieli G, Petraglia F, Bono G et al (1984) Progressive impairment of CSF β-EP levels in migraine sufferers. Pain 18:127–133PubMedCrossRefGoogle Scholar
  34. Hagen K, Einarsen C, Zwart JA et al (2002) The co-occurrence of headache and musculoskeletal symptoms amongst 51050 adults in Norway. Eur J Neurol 9:527–533PubMedCrossRefGoogle Scholar
  35. Hasvold T, Johnsen R (1993) Headache and neck or shoulder pain – frequent and disabling complaints in the general population. Scand J Prim Health Care 11:219–224PubMedCrossRefGoogle Scholar
  36. Higashi Y, Sasaki S et al (1999) Clinical abstracts: vascular disease. Mod Med 67:30Google Scholar
  37. Jennum P, Hein HO, Suadicani P, Gyntelberg F (1994) Headache and cognitive dysfunctions in snorers. A cross-sectional study of 3323 men aged 54–74 years: the Copenhagen Male Study. Arch Neurol 51:937–942PubMedGoogle Scholar
  38. Karakurum B, Soylu O, Karatas M et al (2004) Personality, depression, and anxiety as risk factors for chronic migraine. Int J Neurosci 114:1391–1399PubMedCrossRefGoogle Scholar
  39. Katsarava Z, Fritsche G, Muessig M, Diener HC, Limmroth V (2001) Clinical features of withdrawal headache following overuse of triptans and other headache drugs. Neurology 57:1694–1698PubMedGoogle Scholar
  40. Katsarava Z, Schneeweiss S, Kurth T et al (2004) Incidence and predictors for chronicity of headache in patients with episodic migraine. Neurology 62:788–790PubMedGoogle Scholar
  41. Kelman L (2007) The triggers or precipitants of the acute migraine attack. Cephalalgia 27:394–402PubMedCrossRefGoogle Scholar
  42. Khalil NM, Legg NJ, Anderson DJ (2000) Long term decline of P100 amplitude in migraine with aura. J Neurol Neursurg Psychiatry 69:507–511CrossRefGoogle Scholar
  43. Koseoglu E, Akboyrz A, Soyeur A, Ersoy AO (2003) Aerobic exercise and plasma beta endorphin levels in patients with migrainous headache without aura. Cephalalgia 23:972–976PubMedCrossRefGoogle Scholar
  44. Kruit MC, Van Buchem MA, Hofman PAM et al (2004) Migraine as a risk factor for subclinical brain lesions. JAMA 291:427–434PubMedCrossRefGoogle Scholar
  45. Limmroth V, Katsarava Z, Fritsche G et al (2002) Features of medication overuse headache following overuse of different acute headache drugs. Neurology 59:1011–1014PubMedGoogle Scholar
  46. Linder SL (2005) Do children and adolescents have chornic daily headache? Yes! Curr Pain Headache Rep 9:358–362PubMedCrossRefGoogle Scholar
  47. Lipton RB, Pan J (2004) Is migraine a progressive brain disease? JAMA 291:493–494PubMedCrossRefGoogle Scholar
  48. Lipton RB, Bigal ME, Diamond M, Freitag F, Reed ML, Diamond M, Freitag F, Reed ML, Stewart WF, AMPP Advisory Group (2007) Migraine prevalence, disease burden, and the need for preventive therapy. Neurology 68:343–349PubMedCrossRefGoogle Scholar
  49. Lipton RB, Bigal ME, Ashina S et al (2008) Cutaneous allodynia in the migraine population. Ann Neurol 63:148–158PubMedCrossRefGoogle Scholar
  50. Loder E, Biondi D (2003) Disease modification in migraine: a concept that has come of age? Headache 43:135–143PubMedCrossRefGoogle Scholar
  51. Martin VT, Behbehani MM (2001) Toward a rational understanding of migraine trigger factors. Med Clin North Am 85:911–941PubMedCrossRefGoogle Scholar
  52. Mathew NT (1990) Drug-induced headache. Neurol Clin 8:903–912PubMedGoogle Scholar
  53. Mathew NT, Kurman R, Perez F (1990) Drug induced refractory headache – clinical features and management. Headache 30:634–638PubMedCrossRefGoogle Scholar
  54. Mathew NT, Kailasam J, Seifert T (2004) Clinical recognition of allodynia in migraine. Neurology 63:848–852PubMedGoogle Scholar
  55. McWilliams LA, Goodwin RD, Cox BJ (2004) Depression and anxiety associated with three pain condition: results from a nationally representative sample. Pain 111:77–83PubMedCrossRefGoogle Scholar
  56. Mickeviciene D, Schrader H, Nestvold K et al (2002) A controlled historical cohort study on the post-concussion syncrome. Eur J Neurol 9:581–587PubMedCrossRefGoogle Scholar
  57. Mickeviciene D, Schrader H, Obelieniene D et al (2004) A controlled prospective inception cohort study on the post-concussion syndrome outside the medicolegal context. Eur J Neurol 11:411–419PubMedCrossRefGoogle Scholar
  58. Narin SO, Pinar L (2003) The effects of exercise and exercise-related changes in blood nitric oxide level on migraine headache. Clin Rehabil 17:624–630PubMedCrossRefGoogle Scholar
  59. Obelieneiene D, Bovim G, Scharder H et al (1998) Headache after whiplash: a historical cohort study outside the medico-legal context. Cephalalgia 18:559–564CrossRefGoogle Scholar
  60. Olesen J, Bousser MG, Diener HC, Dodick D, First M, Goadsby PJ, Gobel H, Lainez MJ, Lance JW, Lipton RB, Nappi G, Sakai F, Schoenen J, Silberstein SD, Steiner TJ (2006) Headache Classification Committee: new appendix criteria open for a broader concept of chronic migraine. Cephalalgia 26:742–746PubMedCrossRefGoogle Scholar
  61. Peterlin BL, Calhoun A, Siegel S, Mathew N (2008) Rational combination therapy in refractory migraine. Headache 48:805–819PubMedCrossRefGoogle Scholar
  62. Peterlin BL, Rapoport AM, Kurth T (2010) Migraine and obesity: epidemiology, mechanisms, and implications. Headache 50(4):631–648PubMedCrossRefGoogle Scholar
  63. Rapoport A, Stang ZP, Gutterman DL et al (1996) Analgesic rebound headache in clinical practice: data from a physician survey. Headache 36:14–19PubMedCrossRefGoogle Scholar
  64. Robbins L (1994) Precipitating factors in migraine: a retrospective review of 494 patients. Headache 34:214–216PubMedCrossRefGoogle Scholar
  65. Rossi P, Jensen R, Nappi G, Allena M, The COMOESTAS Consortium (2009) A narrative review on the management of medication overuse headache: the steep road from experience to evidence. J Headache Pain 10:407–417PubMedCrossRefGoogle Scholar
  66. Rothrock JF, Kelly NM, Brody ML, Golbeck A (1994) A differential response to treatment with divalproex sodium in patients with intractable headache. Cephalalgia 14:241–244PubMedCrossRefGoogle Scholar
  67. Rothrock JF, Mendizabal JE (2000) An analysis of the “carry-over effect” following successful short-term treatment of transformed migraine with divalproex sodium. Headache 40:17–19PubMedCrossRefGoogle Scholar
  68. Scharff L, Turk DC, Marcus DA (1995) Triggers of headache episodes and coping responses of headache diagnostic groups. Headache 35:397–403PubMedCrossRefGoogle Scholar
  69. Scher AI, Stewart WF, Liberman J, Lipton RB (1998) Prevalence of frequent headache in a population sample. Headache 38:497–506PubMedCrossRefGoogle Scholar
  70. Scher AI, Stewart WF, Ricci JA, Lipton RB (2003a) Factors associated with the onset and remission of chronic daily headache in a population-based study. Pain 106:81–89PubMedCrossRefGoogle Scholar
  71. Scher AI, Lipton RB, Stewart WF (2003b) Habitual snoring as a risk factor for chronic daily headache. Neurology 60:1366–1368PubMedGoogle Scholar
  72. Scher AI, Stewart WF, Lipton RB (2004) Caffeine as a risk factor for chronic daily headache: a population-based study. Neurology 63:2022–2027PubMedGoogle Scholar
  73. Scher AI, Stewart WF, Lipton RB (2006) The comorbidity of headache with other pain syndromes. Headache 46:1416–1423PubMedCrossRefGoogle Scholar
  74. Scher AI, Midgette LA, Lipton RB (2008a) Risk factors for headache chronification. Headache 48:16–25PubMedCrossRefGoogle Scholar
  75. Scher AI, Stewart WF, Buse D et al (2008b) Major life changes before and after the onset of chronic daily headache: a population-based study. Cephalalgia 28:868–876PubMedCrossRefGoogle Scholar
  76. Schrader H, Stovner LJ, Obelieniene D et al (2006) Examination of the diagnostic validity of “headache attributed to whiplash injury”: a controlled, prospective study. Eur J Neurol 13:1226–1232PubMedCrossRefGoogle Scholar
  77. Stovner L, Hagen K, Jensen R et al (2007) The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia 27:193–210PubMedCrossRefGoogle Scholar
  78. Supornsilpchai W, le Grand SM, Srikiatkhachorn A (2010) Involvement of pro-nociceptive 5-HT(2A) receptor in the pathogenesis of medication-overuse headache. Headache 50(2):185–197PubMedCrossRefGoogle Scholar
  79. Tietjen GE, Brandes JL, Peterlin BL et al (2010) Childhood maltreatment and migraine (part II). Emotional abuse as a risk factor for headache chronification. Headache 50:32–41PubMedCrossRefGoogle Scholar
  80. Tietjen GE, Peterlin BL, Brandes JL et al (2007) Depression and anxiety-effect on the migraine-obesity relationship. Headache 47:866–875PubMedCrossRefGoogle Scholar
  81. Varin R, Mulder P, Richard V, Tamion F (1999) Exercise improves flow-mediated vasodilatation of skeletal muscle arteries in rats with chronic heart failure: role of nitric oxide, prostanoids, and oxidant stress. Circulation 99:2951–2957PubMedGoogle Scholar
  82. Varkey E, Cider A, Carlsson J, Linde M (2009) A study to evaluate the feasibility of an aerobic exercise program in patients with migraine. Headache 49:563–570PubMedCrossRefGoogle Scholar
  83. Wang SJ, Fuh JL, Lu SR et al (2000) Chronic daily headache in Chinese elderly: prevalence, risk factors and biannual follow-up. Neurology 54:314–319PubMedGoogle Scholar
  84. Welch KMA, Nagesh V, Aurora SK, Gelman N (2001) Periaqueductal gray matter dysfunction in migraine: cause or the burden of illness? Headache 41:629–637PubMedCrossRefGoogle Scholar
  85. Wiendels NJ, Neven AK, Rosendaal FR et al (2006) Chronic frequent headache in the general population: prevalence and associated factors. Cephalalgia 26:1434–1442PubMedCrossRefGoogle Scholar
  86. Wober C, Wober-Bingol C, Koch G, Wessely P (1991) Long-term results of migraine prophylaxis with flunarizine and beta-blockers. Cephalalgia 11:251–256PubMedCrossRefGoogle Scholar
  87. Yarmitsky D, Goor-Aryeh I, Bajwa ZH et al (2003) 2003 Wolff Award: possible parasympathetic contributions to peripheral and central sensitization during migraine. Headache 43:704–714CrossRefGoogle Scholar
  88. Zwart JA, Dyb G, Hagen K et al (2003) Depression and anxiety disorders associated with headache frequency The Nord-Trondelag Health Study. Eur JNeurol 10:147–152PubMedCrossRefGoogle Scholar

Copyright information

© Lifting The Burden 2011

Authors and Affiliations

  1. 1.Department of NeurologyCentre for Clinical Neurosciences and Neurological Research, St Vincent’s HospitalMelbourneAustralia
  2. 2.Clinical Professor of NeurologyThe David Geffen School of Medicine at UCLALos AngelesUSA
  3. 3.The New England Center for HeadacheStamfordUSA

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