[Diagnosis and therapy of chronic headaches]

Chronic headaches are defined as headaches occurring more than 15 days per month for several months. In clinical practice, chronic migraine, chronic tension-type headache, hemicrania continua and new daily persistent headache are the most important ones. The differential diagnosis is usually a challenge, as it can be difficult to distinguish symptomatic variants from primary headaches. Medication overuse headache is an important differential diagnosis. Epidemiological studies show that primary forms are predominantly rare with a prevalence of less than 1%. Regarding diagnostic investigations, cerebral MRI scans are the method of choice followed by lumbar puncture. The therapeutic management has to be tailor made. Hemicrania continua is exceptional with its obligatory response to indomethacin, a fact that is crucial for the diagnosis and simultaneously represents the treatment of choice. The group of symptomatic headaches is heterogeneous. Red flags help to judge the necessity of further diagnostic tests.