Chronic Daily Headaches: Diagnosis and Treatment
Chronic daily headaches are often called tension or rebound headaches. In primary care, patients with chronic daily headaches are common. Treating chronic daily headaches are challenging for primary care physicians and patients.
Some of the issues PCPs face when treating these patients include:
- Medicines do not seem to work
- Some patients can’t afford medication
- Underlying psychiatric issues
- Instability at home or work
- Other barriers to effective treatment Discussion points of importance to PCPs:
Incidence of psychiatric comorbidities
- Effectiveness of non-medication treatments, such as yoga
- Evaluation of the “soft signs:” Subtle mood swings and personality traits; signs of depression before age 16; family history of substance abuse, bipolar, institutionalization; depression vs manic or hypomania behavior.
- Setting limits with the patient
- Rebound headache vs medication overuse headache (less common)
- Refractory headaches: what to do when nothing works
- Non-pharmacologic treatment options, such as biofeedback, relaxation training, and behavior interventions.