Treatment of Chronic Daily Headache

Treatment of chronic daily headache may pose problem. Preventive treatment is more important than curative treatment for chronic daily headache (because it is better to prevent than cure).
Treatment of chronic daily headache:

The first step of treatment of chronic daily headache (CDH) is, to try to identify the underlying secondary cause of chronic daily headache, if it can be found. But it is not always easy to diagnose the secondary cause of chronic daily headache. If the underlying secondary cause of the chronic daily headache is found (diagnosed), it should be appropriately treated. Patients with primary chronic daily headache, the headache type will guide the treatment.

Anticonvulsants, like topiramate, valproate sodium, and gabapentin, are also useful in treatment of chronic daily headache. Flunarizine can also be very effective for some patients with chronic daily headache, as well as methysergide or phenelzine.

Preventive treatment of chronic daily headache:

For preventive treatment of primary chronic daily headache, tricyclic antidepressants (either amitriptyline or doxepin) are the drug of choice. Both these drugs at the dose of 1 mg/kg/day are very successful in chronic daily headache. Tricyclic antidepressants should be started at low dose (10–25 mg per day) and should be given 12 hours before the expected time of waking up in the morning, in order to avoid excess morning drowsiness/sleepiness.