Chronic headaches: pharmacological and non-pharmacological treatment

Chronic headaches have increasingly become a focus within the field of head pain. The biological and physiopathological origins of chronic headaches probably reside in receptor physiology, but it is also probable that the initiation and sustaining dynamics of this pathological condition involve several other factors. Not all, but most patients with frequent headache eventually overuse their medications, and when this happens (approximately 1%), the diagnosis of medication-overuse headache is clinically important, because patients rarely respond to preventive medications while overusing acute medications. Properly treating medication overuse and preventing relapse require recognition of the different factors that contribute to its development and perpetuation, including some behaviours and psychological elements that are important in sustaining the overuse of medication. The problems concerning the diagnosis, classification and clinical aspects of chronic headaches are mentioned. Also the different therapeutical approaches, pharmacological and non-pharmacological, initial outcomes and long-term durability of treatment are discussed.