Prevalence and Clinical Features of Chronic Daily Headache in a Headache Clinic

Abstract

Although chronic daily headache is regarded as a syndrome encountered in headache clinics, clinical characteristics have only rarely been studied and the condition has not been documented in Thailand. To investigate the prevalence as well as clinical features of chronic daily headache in Thai patients, 220 patients visiting Chulalongkorn Headache Clinic were examined. Sixty cases (27.3%) were diagnosed as suffering from chronic daily headache (male to female ratio, 1:5.7). The average age of these patients was 32.7 +/- 9.6 years. Based on the International Headache Society (IHS) criteria, 30% of patients with chronic daily headache could be diagnosed as suffering from migraine and 36.7% from chronic tension-type headache, whereas the remainder had combined features of both headache types and were not classifiable. Diffuse steady pain was the most common headache type reported (65%), however, associated features characteristic of migraine were often noted. These included photophobia (70%), phonophobia (56.7%) and nausea (43%). Thirty-four cases (56.7%) reported that their headache could be aggravated by stress. Daily use of analgesics was reported in 58.3% of cases. We concluded that chronic daily headache is a common problem. Although the mechanism has not been fully clarified, the prevalence of associated psychological factors and analgesic overuse imply their involvement in the pathogenesis of this condition. The criteria of the IHS are not entirely suitable for diagnosis and classification of this disorder, and modification of this classification system is needed.

Psychosocial aspects of chronic daily headache

“…Between 58% and 71% report difficulties with sleep [5,13]. This is interesting, as sleep disturbance has been noted as an aggravating factor for HAs [12,13].…”

“…Between 58% and 71% report difficulties with sleep [5,13]. This is interesting, as sleep disturbance has been noted as an aggravating factor for HAs [12,13]. Rothrock et al [10] observed that 57% of chronic daily HA sufferers experienced insomnia; however, they did not observe any significant differences in sleep disturbance between chronic daily HA patients as compared to those with episodic HAs.…”

“…They concluded that their chronic daily high intensity HA group may be more psychologically distressed yet not experience greater psychopathology than episodic HA controls. Several other studies [11][12][13] report that psychological symptoms, such as irritability, impaired concentration, depression and anxiety, are present in a large number of chronic daily HA samples. However, these studies did not use standardised measures of these psychological symptoms and had no control groups, so the meaning of these findings is difficult to ascertain.…”

Chronic Daily Headache in Children and Adolescents: A Multi-Faceted Syndrome

“…105 Thirteen percent of adults (8 of 60) in another study, recalled onset of CDH in childhood. 106 These data suggest that CDH may not remit or may only improve partially in a clinically significant number of children; [104][105][106][107] therefore, those at high risk for chronicity (see above) should be targeted for early "aggressive" intervention. 104 Additionally, children with CDH should be followed into late adult life to better define long term outcome; data bases such as those used in Taiwan provide a model to achieve this end.…”

Cefaléia crônica diária primária: apresentação clínica

“…Estes achados foram semelhantes aos de Solomon e col. 3 , que encontraram dor em peso ou pressão em 87% e pulsátil em 29% de sua amostra e aos de Srikiatkhachorn & Phanthumchinda 23 que observaram dor em peso ou pressão em 65% e pulsátil em 46,7% de sua série, mas diferentes dos descritos por Krymchantowski e col. 22 , que relataram dor em pressão em 36,2% e pulsátil em 37,2% de 215 pacientes estudados. A associação de dor em peso ou pressão e pulsátil foi observada em menos de 6% dos pacientes deste estudo e em 17,2% dos pacientes da série de Krymchantowski e col. 22 .…”