• J Headache Pain · Oct 2007

    Review

    The differential diagnosis of chronic daily headaches: an algorithm-based approach.

    • Marcelo E Bigal and Richard B Lipton.
    • Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Rousso Bldg, Room 330, Bronx, NY 10461, USA. mbigal@aecom.yu.edu
    • J Headache Pain. 2007 Oct 1; 8 (5): 263272263-72.

    AbstractChronic daily headaches (CDHs) refers to primary headaches that happen on at least 15 days per month, for 4 or more hours per day, for at least three consecutive months. The differential diagnosis of CDHs is challenging and should proceed in an orderly fashion. The approach begins with a search for "red flags" that suggest the possibility of a secondary headache. If secondary headaches that mimic CDHs are excluded, either on clinical grounds or through investigation, the next step is to classify the headaches based on the duration of attacks. If the attacks last less than 4 hours per day, a trigeminal autonomic cephalalgia (TAC) is likely. TACs include episodic and chronic cluster headache, episodic and chronic paroxysmal hemicrania, SUNCT, and hypnic headache. If the duration is > or =4 h, a CDH is likely and the differential diagnosis encompasses chronic migraine, chronic tension-type headache, new daily persistent headache and hemicrania continua. The clinical approach to diagnosing CDH is the scope of this review.

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