Chronic daily headache

Headache is a relatively neglected neurological disorder. Indeed, many neurologists find outpatient headache management--particularly of chronic daily headache--one of the least engaging parts of their job. The neglect of headache as a research problem has been reversed by the relatively recent emergence of strong programmes in centres such as Copenhagen, London, Philadelphia, New York, Liege and Leiden. Partly as a result of this, the pejorative attitude to headache as a clinical problem is less than it was, but many neurologists are still bemused by the intrusion of headache, both at a local level when headache patients occupy scarce specialist beds, and at a global level where the World Health Organization ranks migraine in the top 20 causes of global disability. This article reviews one of the commonest headache syndromes encountered by neurologists--chronic daily headache.