Treatment of comorbidities of chronic daily headache

The treatment of chronic daily headaches should focus not only on establishing an effective plan for pain therapy but also on addressing factors that may diminish progression from episodic headache toward chronic daily headache. These measures may translate into better treatment efficacy and satisfaction, as well as decrease the headache burden. Because episodic migraine progresses to chronic daily headache in some (not most) individuals, research will increasingly focus on identifying factors associated with progression, such as specific genetic and environmental risk factors, including comorbidities. Ultimately, the assessment of the migraine patient will include an evaluation of risk factors for progression. In addition to the symptom profile, evaluation will increasingly focus on comorbidities, ictal and interictal functional consequences of migraine, health-related quality of life, treatment needs, and treatment preferences. Estimation of the risk of progression will incorporate assessments of comorbidity, exposures, and eventually biomarkers. Those with high risk of progression will be more aggressively treated, not just to relieve current pain and disability but to prevent progression. Therefore, treatment will focus on decreasing current burden and preventing future burden.