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Chronic
daily headache
Another
type of headache that has not been satisfactorily characterized by the
IHS is that of chronic daily headache (Mathew et al., 1990; Mathew,
1993). Chronic daily headache is a widespread clinical problem and
comprises almost 40% of patients seen in specialty headache clinics. It
was once thought that all chronic daily headaches were chronic
tension-type headaches, however, from clinical studies it is clear that
these are different types of headaches, in fact, tension-type headaches
form only a minority. Headaches may be classified as follows:
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I.
Chronic tension-type headache - form only 10% |
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II.
Migraine chronic tension-type headache complex |
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A.
Transformed from episodic migraine |
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B.
Transformed from episodic tension-type headache which are either
drug-induced or non-drug related. |
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III.
Chronic new persistent daily headache |
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IV.
Post-traumatic headache |
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It
turns out that the majority of these headaches are due to excessive use
of symptomatic medication. This includes the category of transformed
migraine in which people with migraine headache begin to use excessive
amounts of over-the-counter medication. The patients develop a tolerance
to medication over a period of time, needing more tablets to control the
headache. They, then, develop withdrawal symptoms of the medication now
withdrawn and get daily headache. These medications include non-steroidals,
aspirin, and other over-the-counter analgesics.
Some
believe that Chronic Daily Headache is the most common headache
syndrome in the US in the 21st century. I have encounter patients
taking over 200 analgesic pills per week or even opiate injections every
three hours when all they are having is rebound headache. After
strict regimentation and gradual reduction of analgesic medication these
patients are now virtually headache free. See further discussion
of Therapy
for Chronic Daily Headache in my migraine chapter.
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