In general, neurologists consider headaches more often than 15 days per month to be daily headache. Some of these daily headache types are quite clear - such as chronic cluster headache. In this case, the headaches keep their typical characteristics of cluster headache and just become present on a daily or near daily basis for an extended length of time. Unfortunately, when migraines become chronic and daily and then tension headaches become chronic and daily, their symptoms seem to become more alike. In addition, a large number of these patients are taking daily medication and the issue of medication rebound becomes important. Furthermore, some patients will present with the history of never having an intermittent headache of any type and no significant medication use. Their symptoms will again be very similar to the three other groups (intermittent migraine evolving to chronic migraine, episodic tension-type headache evolving to chronic tension-type headache, and overuse headaches).

Patients who present with daily headaches or near daily headaches need a significant evaluation to determine if there is a systemic cause for which the daily headache is only a symptom - such as brain tumors, meningitis (infection of the lining of the brain), systemic infection, some vitamins and herbs, and sleep apnea to name just a few. Studies including imaging studies, blood work, and at times spinal taps are commonly performed. Once secondary diseases seem to be eliminated, then one is left with the considerations of the diseases mentioned in the prior paragraph.

Headaches that are associated with daily pain medication use of any type (over the counter or prescription) will usually not get better without the patient discontinuing the daily pain medication. It is amazing the number of patients who will tell me the medications that they have been taking do not help but they continue to take them anyways. Once it is explained that their headaches will not get better without discontinuing the daily medication, many patients can do this as an outpatient. Sometimes, however, patients have to be admitted to the hospital to achieve this. If admitted, it is customary to place these patients on injections of DHE-45 in order to more rapidly stop the headaches.

Patients who previously had intermittent migraines and then developed daily headache are treated with the medications outlined in the migraine prevention web page. Patients who previously had episodic tension-type headaches and then began to have daily headaches are treated according to the medications outlined on the chronic tension-type headache page. There is a lot of overlap of medications. The originally used I.H.S. system of classification did not differentiate between different types of near daily headache. This has been corrected in the new system IHCD II, but studies based on this are just now starting. It is unclear how best to treat patients who begin suddenly to develop daily headache except to say this group is evaluated most extensively for some systemic cause of their headache.