Chapter Headings / Table of Contents

Chronic Daily Headache



Table of Contents

Chapter 1

What is Chronic Daily Headache?

Distinguishing Primary Headaches to Secondary Headaches. Where should CM be?

Is my Headache a Chronic Daily Headache?

Are there Canadian migraine neurologists with knowledge of this issue?

So where do I find further information for myself, a medical student or a physician? 

Medication Overuse Headache (MOH)

A Toronto headache neurologist speaks out on the various subtypes of CDH


Chronic Migraine (formerly Transformed Migraine) 

Chronic Tension-Type Headache

New Daily Persistent Headache 

Hemicrania Continua 


Preventative Therapy 

Types of Chronic Daily Headache (CDH)

Chronic Migraine (CM)

Chronic Tension-type Headache (CTTH)

New Daily Persistent Headache (NDPH)

Hemicrania Continua (HC) 

Prevalence of CDH

Treatment of CHD

Non-drug approach: 

Drug approach:

Types of Chronic Daily Headache


Chapter 2

What is Chronic Migraine (CM)? Global Estimates

Classification of CM in Wolff’s Headache and Other Head Pain (textbook for physicians) 

Definition of CM as it is defined by the International Headache Society (IHS)

Prevalence of CM in Canada 

Prevalence of CM in the United States 

What impact does CM have on our society?

If hospitalization is Required to treat CM’s where do I Find Help?


United States 

Stages of Chronic Migraine 

Why you should Try to Bring your CM’s back to Episodic Migraine

Interview with Dr Joel Saper, Headache Neurologist, Michigan Headache & Neurological Institute, Ann Arbor, Michigan

Botox for Chronic Migraine


Chapter 3

Migraine in Women

Migraine and the Menstrual Cycle

Non Pharmacologic Rx

Migraine and Oral Contraceptives

Migraine and stroke – is there a link? 

What is a stroke? 

Is there a risk of stroke during a migraine attack? 

What do the statistics show about migraine and stroke? 

Why should young women with migraine with aura be at anincreased risk of stroke? 

What are the implications?

What about older people with migraine? 

Migraine and Pregnancy

Management of Migraine in Pregnancy

I am pregnant / breastfeeding and experiencing migraine 

Migraine and Menopause

From the Section on Menopause


Chapter 4

ACUTE MEDICINES (or Abortive Medicines)

Categories of Acute Medicines

Over-the-Counter Medicines (OTCs)

“Just Take a Pill”: Consumer’s Perception of Over-the-Counter Medication

Behaviour Modification when Treating Headache

Patient Assistance Programs

Risk Factors that can Lead the Headache Sufferer toward Developing Chronic Daily Headaches

New Migraine Treatment: Cambia®


Chapter 5

What are preventative medicines? How a Migraine is treated with Preventative Treatment?

How do Preventative Medicines work? What is their purpose?

Prevent the Next Migraine Attack in Frequency, Severity, & Length

When to Use Preventative Treatments to treat Migraines?

Which preventive medications should be used?

A strategy for patients who are overweight

Depression / anxiety strategy for patients who have depression and / or anxiety in addition to migraine


Issues to consider when taking preventative medicines

Categories of Preventative Medicines



Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) 

Calcium Channel Blockers 


Monoamine Oxidase Inhibitors (MAOIs) 

Anticonvulsants or Antiseizure Medications 

Botulinum Toxin Injection (see Chapter 2) 

Alternative Preventatives 

Headache and Migraine Patients searching for Financial Assistance

What Preventative Medicines are used to treat Chronic Daily Headache?

Preventative Medicines used for Chronic Daily Headache

Table 1: Brief Summary of some Prophylactic Drugs used to treat Chronic Daily Headache Types


Chapter 6

Alternative Approaches

Herbs, Supplements and Botanicals



Coenzyme Q10 (CoQ10)

Migralex (a newer treatment)


Butterbur (Petasites hybridus)

Physical Approaches


Chiropractic Manipulation

Cranial Sacral Therapy



Physical Therapy



Electrical stimulation of the occipital nerve

Behavioural Treatments

Relaxation Techniques

Cognitive Behavioural Therapy (CBT)





Multidisciplinary Headache Treatment Centres



Chapter 7

Medication Overuse: A Brief Mention

Patients can become hopelessly stuck

Do not expect immediate results

Depression and Anxiety in Migraine Patients

Symptoms of depression and anxiety are most common among persons with chronic migraine

Warning Symptoms - Especially Feelings and Thoughts

Anxiety Types

Treatment Options

Information From Research and a Simple Treatment Plan

Risk Factors For a Sleep Disorder

More on Sleep Plans

Caffeine, Snoring and Chronic Daily Headache

Methods of the Study

Caffeine and Medication




Stumbling Blocks When Accessing Care

Medicines Not Covered

Alternatives Not Covered

Co-existing Conditions

Research Funding

Numerous Referrals

Internet Health (Sometimes Good, Sometimes Bad)

More People in the World


Chapter 8


1. Lifestyle Changes

2. Trigger avoidance

Patient Compliance/Adherence

Adherence: What is it and why does it matter?

Motivation and Behavior Change

Partnership and Communication with your HCP

What can you do to Manage your Headaches? 

What are Headache Triggers?

What is Relaxation Training and Stress Management?

Headache Diary

Headache Diary Instructions

Why the Headache Diary is such an Important Tool for Physicians

Relaxation Techniques

What Are Some Relaxation Techniques I Can Use to Help my Headaches?


How do I find a Headache Doctor with a High Interest in Treating Headaches?


Chapter 9

Diagnostic Tests

Magnetic Resonance Imaging (MRI)

Computerized Tomography Scan (CT)

Electroencephalograms (EEG)

Lumbar Puncture (LP)

Miscellaneous Tests

Online Headache Assessment Tools Available

Headache Impact Test (HIT) 

Migraine Disability Assessment (MIDAS)

Do I Need an Imaging Study for my Headache?


Imaging studies used to examine headache


Chapter 10

How a Doctor Diagnoses Headache

How long have you had these headaches?

Do other members of your family get headaches?

How often do you get these headaches?

Has the pattern or frequency changed?

Describe the pain for me

What other symptoms do you have with the headache attacks?. 210 How long does the headache attack last?

Do you tend to get your headaches at a particular point in the day, week or month?

Have you noticed or has your family noticed a change in your mood or behaviour because of these headaches?

Do you get any warning that a headache is coming on?

What do you take to try to stop a headache? How much do you take?

What seems to trigger your headaches?

Your Doctor and Your Headache - A Vital Partnership

Getting the most from your doctor

Getting the most out of your appointment

Specialist clinics

Reasons Why you Should Search for a New Doctor

Physicians Should not Blame the Patient

Blaming the Patient

Patient-Centred Care


Chapter 11

Life and Migraine - Documentary about Life with Chronic Migraine

Organizations and Centres specific to helping Headache Sufferers

Finding the Key to the Migraine Riddle



Appendix I

Why Patients do not Get Better (for some CDH sufferers)


Appendix II

How to View the Headache Classification guide, produced by the International Headache Society (IHS)





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The opioids (narcotics) cause progression of the illness (Chronic Daily Headache), not termination, and will actually make the individual much worse over time. It is easier and quicker to give the patient a pain killer than to "get into the trench" and try solve the problem. Patients with chronic daily headache require time, diligence, and frequent access from their physician.

Interview: Dr. Joel Saper, MHNI
-from the book Chronic Daily Headache

Click a province on the map above
or the list below:
   British Columbia

New Brunswick 
   Nova Scotia 
Prince Edward Island 
Newfoundland / Labrador
Northwest Territories 
Yukon Territories

The book Chronic Daily Headache features
an article reviewed by a Headache Neurologist
entitled "Why Some Headache Patients do
not Improve"!