Chronic daily headache and medication overuse headache: clinical read-outs and rehabilitation procedures

The impact of headache on the person and society represents a public health issue. Recently a study evaluated 51% of headache's prevalence in Europe, of which 14% is affected by migraine. Besides, 4% of adult population is affected by chronic forms, which constitute therefore an even more relevant problem in terms of health and social policies. The International Classification of Headache Disorders, II version (ICHD-II) recognises 24 types of chronic headache and states primary episodic headaches as chronic when attacks appear for more than 15 days per month, for at least three months. Headache given by drugs overuse, defined by ICDH-II in 2004 (and revised in 2005) as Medication Overuse Headache (MOH), is associated with overuse of a combination of analgesics, barbiturates, opioids, ergot alkaloids, aspirin, AINS, caffeine and triptans. Patients affected by MOH present a reduced work performance and a significant alteration in the quality of life. Furthermore, some psychological and behavioural states seem particularly important in promoting and sustaining drug abuse. The management and rehabilitation of patients affected by CDH, abusing symptomatic drugs, consists in the withdrawal and/or gradual reduction of their assumption, because of tolerance and addiction possibilities.