[Chronic daily headache: II. Treatment]

The difficulty involved in treating chronic daily headache (CDH), a frequent pathology with a multifactorial aetiology, makes it a challenging disorder for clinicians. CDH is a disease that causes significant impact on patients, employers and the health system.

The treatment of CDH is based on the implementation of three therapies. The first is to establish a pharmacological treatment, with medication such as antidepressants, antiepileptic agents, muscle relaxants, and antihypertensive and antiserotoninergic drugs, either in mono or in polytherapy. The second measure is to stop the analgesic overuse. This is achieved by suddenly withdrawing the drugs or, in a combined manner, by stopping the analgesic intake and establishing bridge therapy (steroids or triptans), which, in addition to reducing the severity and frequency of seizures and the consumption of drugs, also help to lower the occurrence and duration of withdrawal symptoms. Hospital treatment is needed in cases of patients who are refractory to multiple therapies, with frequent visits to the emergency department, in presence of associated symptoms or comorbidities, and low tolerance to medication. The third measure is to implement non-pharmacological therapies, which are used to modify inappropriate behaviour as regards pain treatment, to promote proper medication consumption and to allow the patient comprehend the prognosis of the disease with and without treatment.

Implementing these three therapies makes possible to reduce the severity, frequency and socioeconomic impact caused by headache and thereby improve patients' quality of life and capabilities.