Management of Chronic Daily Headache: Challenges in Clinical Practice


  • Joel R. Saper MD, FACP, FAAN,

  • David Dodick MD, FRCP(C), FACP,

  • Jonathan P. Gladstone MD

  • From the Michigan Head Pain and Neurological Institute, Ann Arbor, MI (Dr. Saper) and Mayo Clinic Scottsdale, Department of Neurology, Scottsdale, AZ (Drs. Dodick and Gladstone).

Address all correspondence to Dr. Joel Saper, Michigan Head Pain and Neurological Institute, 3120 Professional Drive, Ann Arbor, MI 48104-5131.


Chronic daily headache (CHD) refers to a category of headache disorders that are characterized by headaches occurring on more than 15 days per month. This category is subdivided into long- and short-duration (>4 or <4 hours) CDH disorders based on the duration of individual headache attacks. Examples of long-duration CDH include transformed migraine (TM), chronic migraine (CM), new daily persistent headache (NDPH), acute medication overuse headache, and hemicrania continua (HC). The goal of this review is to enable clinicians to accurately diagnose and effectively manage patients with long-duration CDH. Patients with CDH often require an aggressive and comprehensive treatment approach that includes a combination of acute and preventive medications, as well as nondrug therapies.