July 17, 2000 -- When is a headache more than just a headache? If you have had tension or migraine headaches at least 15 days a month for six months or more, you may suffer from a condition known as chronic daily headache (CDH).
Although CDH affects only about 2% of the population, it can seriously disrupt the lives of those who live with it. Now, research has uncovered some new clues about what may cause CDH and has shown that some simple techniques can ease its symptoms, according to researchers attending a meeting of the American Headache Society in Quebec.
Prior headaches, a family history of headaches, head injuries, and fibromyalgia -- a painful and sometimes debilitating disorder involving muscles, ligaments, and tendons -- are all associated with CDH, but their exact roles are not yet clear.
To explore the role injury plays, researchers compared more than 200 CDH patients, with and without a history of brain injury. "Both groups were similar in age, sex, and symptoms, but the data suggest that head injury can produce CDH, even when there are no other risk factors," says study author James Couch, MD, professor and chairman of neurology at the University of Oklahoma.
Similarly, Brazilian researchers compared more than 100 CDH patients, some of whom had fibromyalgia and some who did not. Both groups were mostly female, but the patients who also had fibromyalgia tended to be older than the others and had more incapacitating headaches and insomnia, the researchers say.
In some cases, one way to prevent these headaches, believe it or not, is to stop taking pain medication -- or at least, stop taking it incorrectly.
"If you're taking prescription or over-the-counter analgesics more than twice a week, you may be causing your daily headaches," says Stephen Silberstein, MD, director of the Jefferson Headache Clinic and professor of neurology at Jefferson Medical College, both in Philadelphia.
These so-called drug rebound headaches result from overuse of the headache medication: The headache returns as each dose of the medicine wears off, prompting the patient to take more and leading to a cycle of headaches and drug overuse.
There are some other simple techniques that may stop the pain, Silberstein tells WebMD. "Eating regular meals, getting plenty of exercise, and learning how to manage stress are some other keys to prevention," he says. And "by all means, limit your intake of MSG, caffeine, and alcohol." He also notes that many patients have found relief after mastering muscle relaxation through biofeedback.
A study led by Ninan Matthew, MD, a clinical professor of neurology at the University of Texas, found that four months of treatment involving the types of methods suggested by Silberstein could significantly decrease the symptoms of CDH.
In Ninan's study of more than 200 patients, the initial treatment included detoxification from pain medication, plus intravenous therapy with a drug called dihydroergotamine (DHE). It's not yet known how DHE and detoxification work, but they're thought to reset the brain for normal functioning. Later, the study participants were given behavioral and dietary counseling, as well as biofeedback and physical therapy.
The researchers, at the Houston Headache Clinic, measured the patients' responses using a questionnaire called the Migraine Disability Assessment Tool (MIDAS).
"Disability was strongly correlated with headache frequency, but after four months of treatment, MIDAS scores decreased significantly," says Mathew, who also is past president of the International Headache Society.
- Chronic daily headache (CDH) is defined as having tension or migraine headaches at least 15 days per month for at least six months.
- Other conditions associated with CHD are prior headaches, family history of headaches, head injury, and fibromyalgia.
- Exercising, avoiding certain foods, and, sometimes, stopping certain medications, are all ways to help prevent chronic headaches.