Chronic daily headache

• 5% of North American and Western European populations have headache on at least 15 days a month for, on average, four or more hours a day
• a chronic daily headache is not just tension-type headache, nor is it all just due to medication overuse
• if a doctor gets a history of frequent headache they need to pursue its basis
• clinician needs to be aware of features suggestive of sinister or secondary headache. These include:
  • pain of sudden onset
  • fever
  • marked change in pain character or timing
  • neck stiffness
  • pain associated with higher centre complaints
  • pain associated with neurological disturbance e.g. clumsiness or weakness
  • pain associated with local tenderness, such as of the temporal artery
  • if a positive diagnosis that the headache is benign cannot be made then patients with a headache that is of recent onset or with neurological signs require brain imaging with computed tomography or magnetic resonance imaging

Reference:

1. NICE. Headaches in over 12s: diagnosis and management. Clinical guideline CG150. Published September 2012, last updated June 2025