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Chronic daily headache relates to the daily or almost-daily occurrence of headache. However, not all daily or almost-daily headaches fall under this denominator, as is the case with the daily or almost-daily headaches of (chronic) cluster headache and paroxysmal hemicrania, as well as those of hypnic headache or nocturnal migraine. These conditions can be referred to as paroxysmal daily headaches in which the headaches occur in well-defined attack patterns. In cluster headache, the attack pattern is that of headaches occurring once or twice a day and lasting 1 to 2 hours, whereas in paroxysmal hemicrania, it is that of headaches occurring 5 to 15 times per day and lasting 10 to 30 minutes. In hypnic headache or nocturnal migraine, the headaches occur once a day, waking the patient from sleep at night, usually between 4 and 6 am, and lasting for a variable amount of time, also depending on the efficacy of treatment.


Of the nonparoxysmal daily headaches, hemicrania continua is a condition that does not fall under the denominator of chronic daily headache, either. However, it is discussed in this chapter because it is very difficult, if not impossible, to distinguish from chronic daily headache on the basis of presentation alone. It differs from chronic daily headache in having a somewhat more consistent and less variable intensity of the pain and in an absolute response to preventive treatment with indomethacin.


Chronic daily headache is not the same as chronic tension-type headache, as defined by the International Headache Society (IHS).1 The IHS defines chronic tension-type headache as headaches with an average frequency of 15 days per month (180 days per year) or more for at least 6 months. In addition, the headaches must have at least two of the following features: pressing quality, mild or moderate intensity, bilateral location, and no aggravation by routine physical activity. Both of the following have to apply: no vomiting and no more than one of the following symptoms: nausea, photophobia, or phonophobia. Finally, the following conditions must be met: the history as well as the physical and neurologic examination do not suggest the presence of another cause of headache; if the presence of such a cause is suggested, it is ruled out by appropriate investigations or, if such a cause is present, the headaches did not occur for the first time in close temporal relation to occurrence of the disorder.


Although it is stated in the IHS classification that sometimes migraine gradually transforms into chronic tension-type headache, in my opinion, that is incorrect. Migraine may, however, transform into chronic daily headache, as discussed later. The confusion stems from the fact that the IHS identifies chronic daily headache as a synonym for chronic tension-type headache, which is incorrect. Chronic daily headache is, rather, a replacement for the old term, mixed or combined headache. In the practice of medicine, the group of patients with this condition is also the majority ...

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