Prophylactic Pharmacological Treatment of Chronic Daily Headache

Objective.—To review all the prophylactic pharmacological treatments for chronic daily headache from the past decade. Background.—Chronic daily headache is among the most common diagnoses seen in specialized headache centers. Prior to 1988, there were no criteria for the diagnosis of chronic tension‐type headache and chronic daily headache. An expanded chronic daily headache classification has been proposed. Methods.—A MEDLINE search was performed using the following key words: chronic daily headache, intractable headache, transformed migraine, chronic tension headache, and chronic tension‐type headache. We limited our review to those studies published in English in the last decade, including published abstracts and letters to the editor. Double‐blind studies carried out prior to 1988 were also included. Results.—Pharmacological treatments for chronic daily headache include antidepressants (tricyclics, tetracyclics, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors), anticonvulsants, muscle relaxants, 5‐HT 1 agonists, ergots, 5‐HT 2 antagonists, antianxiety agents, and miscellaneous drugs. Many of these reports are anecdotal, and most are open rather than double‐blind studies. Conclusions.—There is a great variety of pharmacological treatments available for chronic daily headache. Only the antidepressants have been extensively studied. Other medications may be used if these fail. Recommendations based on our experience at the Headache Unit of the Montefiore Medical Center are outlined here.