Medical Chronicle November/December 2013 | Page 31

PAIN

Chronic headaches:
Current insights
Most people have headaches from
time to time. When a patient has a
headache more days than not, this is
known as chronic daily headaches.
These are among the most disabling
headaches. Aggressive initial treatment
and long-term management can reduce
pain and lead to fewer chronic daily
headaches.
By definition, chronic daily headaches must occur 15 days or more a
month, for at least three months. To be
considered true (primary) chronic daily
headaches; they must also not be the
result of another condition.
The most common primary headache
disorders are tension-type headache,
and migraine and cluster headache.
There are, however, many less commonly occurring primary headache
disorders. Despite a much bigger focus
on headache disorders, there is still a
major educational task regarding both
the etiology and treatment of headache
for both the patients and the treating

health professionals. There is a significant risk for progression from episodic
to chronic daily headache, which makes
the appropriate treatment of headache
early on very important. At the same
time, the inappropriate overuse of
analgesic medication carries the risk of
causing medication-overuse headache
(MOH). This has developed into the third
most common type of headache after
tension-type headache and migraine.
This currently affects approximately 1%
of the world’s population and is increasing. The pathophysiology of MOH is still
unknown. The overuse of any kind of
acute headache medication is the main
risk factor leading to the development
of chronic headache.

CHRONIC DAILY HEADACHE
Classification and diagnostic
criteria
Chronic daily headaches are classi-

DR ERIC HODGSON Neurologist in private practice,
Life Wilgers Hospital and PainSA President

fied by how long they last - more than
four hours or less than four hours. The
longer-lasting headaches are more
common and will be discussed here.
They’re divided into four types:
• Chronic migraine
• Chronic tension-type headache
• New daily persistent headache
• Hemicrania continua.

CHRONIC MIGRAINE
These headaches evolve from
episodic migraine without aura. This
is a very important category, since
new treatment options have become available for this condition. To
be diagnosed with chronic migraine,
headaches - migraine, tensiontype or both - must be present 15
days or more a month, for at least
three months. In addition, on eight
or more days a month for at least
three months, headaches with at
least two of the following charac-

teristics must be present:
• Affect only one side of the head
• Cause a pulsating, throbbing sensations
• Cause moderate to severe pain
• Are aggravated by routine physical
activity.
And they cause at least one of the
following:
• Nausea, vomiting or both
• Sensitivity to light and sound.
Response to triptan medication
can also be helpful in making this
diagnosis.
Chronic migraine (CM) is a complex, progressive headache disorder
affecting approximately 1%-2% of the
general adult population. Patients
with CM are less likely to attend social functions and perform household
work, and one in five CM sufferers
are occupationally disabled, thereby
affecting their ability to lead productive lives.

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2013/11/05 8:14 AM

MEDICAL CHRONICLE NOVEMBER/DECEMBER 2013 31