Chronic Daily Headache vs. Chronic Tension-Type Headache

Confused about the difference between chronic daily headache and chronic tension type headache?  Let’s talk about it.

This month a report came out about the use of Botox for various headache disorders.  The meta-analysis (a study of earlier studies) concluded that Botox had been helpful for "chronic daily headache" and "chronic migraines", but had not yet been proven useful for "episodic migraine" or "chronic tension-type headache".

Now of course this doesn’t prove too much – just that the studies so far seem to show that Botox is more useful for people with some diagnoses and not for people with other diagnoses.  It could mean some have been studied more than others, or that we have not yet found the right type of Botox treatment, or it could mean that Botox simply isn’t useful in some conditions.  We don’t really know.

But what stood out to me was the use of the term chronic daily headache.  What does that term actually mean?  And why is it different from chronic migraine or chronic tension-type headache?

Having not read the full study, I’m not sure how the authors are using the term, but I suspect from the abstract that they’re taking it from the studies they’re using.  Which makes things even more tricky.

Chronic Daily Headache (CDH) is not really a specific term for a headache disorder, but a general term.  This means that chronic migraine and chronic tension-type headache could both be called chronic daily headache.

CDH could be:

• chronic cluster headache
• chronic migraine
• chronic paroxysmal hemicrania
• chronic tension type headache
• hemicrania continua
• new daily-persistent headache
• short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing

With all of these disorders, attacks come either constantly or at least 15 days a month.  CDH are a huge problem.  It has been estimated that up to 5% of the population have significant CDH symptoms.  Most have chronic migraine.

Often CDH is related to the overuse of medication (such as triptans or acetaminophen / paracetamol, in which case you may be diagnosed with one of the above and medication-overuse headache, or it could be diagnosed as one or the other.

Because of the confusion over the terminology, or simply ignorance about the classifications, many patients are diagnosed with chronic tension type headache when they really have a different type of CDH.

Chronic Tension-Type Headache starts with episodic tension-type headache.  In other words, first the patient has the occasional TTH, and later ends up with chronic TTH.  Usually there’s pain on both sides of the head, feeling like a pressing or tightening.  Physical activity probably won’t make it worse, but there is sometimes some mild sensitivity to light or noise, and possibly a little nausea (but not vomiting) – one, but not all three.

Chronic migraine, in contrast, usually starts with migraine attacks which eventually become chronic.  The symptoms are migraine-like.

Now with both chronic migraine and chronic tension-type headache, your doctor will want to rule out other conditions.  It is possible to have the symptoms of chronic TTH, and yet actually have a different diagnosis.

If you have been diagnosed with CDH, try to get a more specific diagnosis.  Why?  Because as research continues, there are treatments that will be more likely to help you depending on which type of chronic condition you have.  The more you can narrow it down, the quicker you can get treatment that works.

For more of a breakdown of CDH types, see the National Headache Foundation’s topic sheet on Chronic Daily Headache.