What is Chronic Daily Headache?
Chronic Daily Headache (CDH) is a relatively newly headache type classified by the International Headache Committee1. It is categorized by chronic headache occurring on >15 days per month for at least 3 months1,2,3. Some sufferers of this condition have had migraine that has changed/ transformed, others may have CDH as a first time new onset episode or from some other previous headache type that increases in its severity and frequency to become chronic and daily2,3.
CDH, also known as daily persistent headache, often has features of migraine such as nausea or sensitivity to light or sound and many people wake every day with a headache and have it last all day2,3!
Because of the frequency and life dominating nature of CDH, one of the main concerns with this type of headache is the risk of some sufferers becoming dependant on painkillers3. As painkillers wear off, a rebound headache can occur, leading to the sufferer wanting to take more tablets, but many painkillers taken often (especially codeine/caffeine based meds) actually fuel further headache. This can lead to Medication Overuse Headache, which may be linked causally with a CDH diagnosis.
It is important to try and break this cycle by reducing / stopping overuse of painkillers especially those containing codeine and caffeine and shift the focus to treating the root cause rather than chasing symptoms with medications that can have harmful side effects.
What is the cause of Chronic Daily Headache?
In the literature many factors are cited as possible causes for CDH like; stress, prior neck, head or spinal injury, infections or inflammatory disorders, overuse of analgesics, sleep disorders, depression / anxiety and inadequate management of migraine2,3,5. Others blame genetic or inherited causes largely, but clinical wisdom says “genetics may load the gun but environment pulls the trigger” – so even though a genetic cause may be postulated, there must be other key (and thus treatable) factors?
So what is the real cause of Chronic Daily Headache?
Thankfully, research is now revealing what every chronic headache and migraine sufferer knew all along, namely it’s not “all in your head!” (or just “bad genetics” for that matter!). In fact, what is emerging is the fact of a common pathway or “headache headquarters” in the brainstem where multiple neurons converge. This specific region is called the Trigeminocervical complex (TCC) and is a “holy grail” of sorts for both researchers, clinicians and sufferers alike. Furthermore, recent studies have revealed that one of the most powerful causes of brainstem sensitivity is the upper neck or Cervical spine4,6,7.
Even between an episode or attack, research shows that chronic headache and migraine sufferers exhibit a sensitized brainstem. This explains why even normal stimuli is registered by a migraineur’s nervous system as a stressor or trigger for an attack…it is normal everyday stressors activating an already sensitized brainstem.
During an attack an already sensitized brainstem (by the neck or other causes) is activated by a trigger, which then sets off an explosive positive feedback loop from the brain cortex and back to the brainstem. The already “cranky” hyper sensitized brainstem fires and the cortical brain cells respond with cortical spreading depression causing inflammation of the blood vessels, dura and local tissues in the face, head and neck.
The trigeminal nerve (a nerve that supply’s sensory and some motor control to the face, head, jaw, upper teeth) then picks up this amplified signal and becomes inflamed and sensitized itself lighting up pain and further reactions which then sends powerful signals back to the brain stem and the pain neuromatrix…and the vicious amplifying cycle continues and causing Chronic Daily Headache Pain.
The good news is this brainstem sensitivity can be treated with an integrated and combined therapy approach, with a critical step being expert screening of the upper neck as a primary contributor of sensitivity in the brainstem3,4.
Our unique combined therapy approach is logical and evidence-based and aimed at decreasing the sensitivity in the brainstem at the “headache headquarters” with a number of safe treatment options individualized to your headache type.
Click the links for more information on how we perform Our Assessment or Our Treatment or to learn more about our revolutionary 4 phase S.T.E.P. into FREEDOM TM program to help you live life headache free!
- Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders, 3rd edition. Cephalalgia 2013; 33: 629–808.
- Silberstein S.D., Upton R.B., Dalessio D.J, eds. Wolff’s Headache and Other Head Pain. 7th edition. New York. New York: Oxford University Press: 2001.
- Goadsby P.J., Silberstein S.D., Dodick D.W., ed. Chronic Daily Headache for Clinicians. Hamilton, Ontario: BC Decker Inc; 2005.
- Watson D, (2015) “Sensitive New Age Migraine”; video lecture
- Silberstein S.D., Chronic Daily Headache. J Am Osteopath Association, 2005: 105:S23-S29. 4. Li D., Rozen T.D. The clinical characteristics of new daily persistent headache. Cephalalgia. 2002; 22:66-69
- Watson D. and Drummond (2014). “Cervical Referral of Head Pain in Migraineurs: Effects on the Nociceptive Blink Reflex””Cephalalgia. 54: 1035-1045. Doi 10.1111/head.12335.
The Headache + Migraine Clinic
Telephone: 1300 HOPE 4 YOU (1300 467 349)
Brisbane West (Springfield Central)
Suite 3, Level 1, Orion Springfield Central
1 Main Street, Springfield Central QLD 4300