What is Chronic Daily Headache?

Chronic Daily Headache (CDH) refers to headaches occurring on 15 or more days per month for at least three months. It is not a single diagnosis, but rather a group of headache disorders that includes:

  • Chronic tension-type headache (most common)
  • Chronic migraine
  • New daily persistent headache (NDPH)
  • Medication overuse headache (MOH)

These conditions can have a significant impact on quality of life and are often associated with neck pain, sleep disturbance, anxiety, stress, and central sensitisation. Effective management usually requires a combination of lifestyle modification, medication review, education, and targeted interventions where appropriate.

What are the symptoms?

Depending on the type of headache, you may experience:
  • Daily or near-daily headaches that may be dull, pressing, or throbbing
  • Headaches that vary in intensity and location
  • Sensitivity to light, sound, or smells (particularly in chronic migraine)
  • Associated neck pain, fatigue, poor concentration, or mood changes
  • Frequent use of pain relief medication, which may contribute to medication overuse headache (MOH)

How is it diagnosed?

Diagnosis is based on:

  • A detailed headache history, including frequency, duration, associated symptoms, triggers, and medication use
  • Classification into a specific headache subtype (e.g. chronic migraine or medication overuse headache)
  • Exclusion of secondary causes with appropriate investigations, such as MRI, where clinically indicated
  • Use of a headache diary to identify patterns, monitor progress, and assess response to treatment

What treatments do we offer?

We provide a non-surgical, minimally invasive interventional approach to help manage chronic daily headache (CDH) and reduce the burden of persistent headaches.

  • Occipital Nerve Blocks: For headaches involving the back or sides of the head, we may offer greater or lesser occipital nerve blocks. These injections may help reduce headache intensity and frequency, particularly in patients with chronic migraine and chronic tension-type headache.
  • Trigger Point Injections: If muscle tension in the neck, shoulders, or scalp is contributing to your headaches, we may offer trigger point injections. These injections help relax overactive muscles and may reduce associated head and neck pain.
  • Stellate Ganglion Block: In selected patients, particularly those with features of sympathetic overactivity, stress-related symptoms, or associated facial pain, we may offer a stellate ganglion block as part of a broader treatment strategy.
  • Botox® for Chronic Migraine: Botox® is a well-established treatment for chronic migraine when the headache pattern is consistent with migraine. It can reduce headache frequency and severity, with benefits typically lasting 3–4 months.
  • Medication Optimisation: We provide a comprehensive review of your current headache medications, aiming to improve effectiveness while reducing side effects and unnecessary medication use.

Self-Management & Support

  • Advice on lifestyle changes, trigger management, sleep hygiene, and pacing strategies
  • Use of headache diaries to monitor progress and guide treatment
  • Referral to neurology, physiotherapy, or psychology may be suggested in complex or overlapping cases

What to expect from treatment

  • Chronic daily headache can improve with the right combination of medication, interventional treatments, and behavioural strategies

  • Our goal is to reduce headache frequency and severity, support medication reduction, and improve of quality of life

  • All procedures are performed as day-case interventions with follow-up support as needed