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Chronic Daily Headache: Same Old, Same Old

By: Gary Cordingley
"Chronic daily headache" (CDH) refers to the unhappy situation
in which headaches are present at least fifteen days per month.
Headaches can even occur every day or almost every day. CDH is
more of a category than a final diagnosis, and different,
recognizable patterns of headache are included in this category.
It is important to distinguish among the different patterns
because, once recognized, they can indicate the underlying cause
and dictate appropriate treatment.

CDH can occur in the form of either "primary headaches" or
"secondary headaches." Secondary headache means that the
headache is a symptom of some other disease or process. In this
case, the best treatment is the one that addresses the
underlying cause. Primary headache means that the headache
disorder itself is the disease and is not a symptom of something
else.

The most common primary headache condition is "tension-type
headaches." Generally affecting the left and right sides
equally, tension-type headaches often involve the back of the
head and neck, but can also include the front of the head. These
headaches are usually mild to moderate in intensity and have
pressing or tightening qualities. Nausea, photosensitivity and
sound sensitivity are not prominent in this headache disorder
and tension-type headaches do not usually worsen with exertion.

Migraine is another common primary headache disorder which, when
present more days than not, is also categorized as CDH. Migraine
attacks typically last 4-72 hours when untreated. They are of
moderate to severe intensity and often have a pulsating quality.
They show increased tendency to affect just one side of the head
and to include the associated symptoms of nausea, light
sensitivity and sound sensitivity. They usually worsen with
exertion.

While some people have frequent, individual, migraine attacks
that span more than 15 days per month and are therefore
categorized as CDH, another form of migraine involves a blending
together of attacks into a more continuous, never-ending
pattern. This usually occurs in people who previously had the
more recognizable pattern of distinct, individual, migraine
attacks. Just what happens in these cases--or even what to call
it when it does happen--is a source of great debate among
headache experts. One camp of experts calls it "chronic
migraine" and another camp calls it "transformed migraine."

To make matters even more interesting, a person can have more
than one type of headache, for example, a mixture of migraine
and tension-type headaches. When this occurs, the mixture can be
difficult to distinguish from the previously mentioned chronic
(or transformed) migraine.

Two other kinds of primary headache are rarer than migraine and
tension-type headaches, and show quite different
characteristics. These are "hemicrania continua" and "chronic
cluster." Hemicrania continua ("hemicrania" means half-headed
and "continua" means continuous) is a strictly one-sided
headache which can wax and wane in intensity without resolving.
It does not include migraine's usual associated symptoms of
nausea, light sensitivity, sound sensitivity and exertional
aggravation. Chronic cluster, like its less-frequent "episodic"
....[MORE]

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