What is Chronic Daily Headache?

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

  • Chronic Migraine
  • Chronic Tension-Type Headache
  • New Daily Persistent Headache (NDPH)
  • Medication Overuse Headache (MOH)

These headaches can significantly impact quality of life and may overlap with neck pain, sleep disturbance, and stress. Effective management often requires a combination of lifestyle change, medication review, and targeted interventions.

What are the symptoms?

Depending on the type of headache, you may experience:
  • Daily or near-daily headaches that are dull, pressing, or throbbing
  • Headaches that vary in intensity and location
  • Sensitivity to light, noise, or smells (especially in chronic migraine)
  • Associated neck pain, fatigue, poor concentration, or mood changes
  • Dependence on frequent pain relief medication, which may worsen the problem

How is it diagnosed?

Diagnosis is based:

  • A detailed headache history, including frequency, duration, triggers, and medication use
  • Classification into a specific subtype (e.g., chronic migraine, MOH)
  • Exclusion of secondary causes via MRI (if needed)
  • Use of headache diaries to understand patterns and track treatment response

What treatments do we offer?

We provide a non-surgical, minimally invasive interventional approach to help manage CDH and reduce the burden of daily pain:

1. Occipital Nerve Block

  • For headaches involving the back or sides of the head, we may offer greater or lesser
    Occipital nerve blocks
  • These injections can help reduce headache intensity and frequency, particularly in chronic migraine and tension-type headache

2. Trigger Point Injections

  • If muscle tension in the neck, shoulders, or scalp is contributing to headaches, we
    may offer trigger point injections
  • These help release overactive muscle areas and reduce associated head pain

3. Stellate Ganglion Block

  • In selected cases, especially with sympathetic overactivity, stress-related symptoms, or facial involvement, we may offer a stellate ganglion block

4. BOTOX for Migraine

  • BOTOX is a well-established treatment option in Chronic migraine, if the headache the 
    pattern is in keeping with migraine.

5. Medication Optimisation

  • We offer a thorough review of your current headache medications, aiming to improve
    effectiveness and reduce risks.
  • In line with local prescribing guidelines, we do not prescribe opioids or pregabalin. These should be managed by your own GP or neurologist.
  • We can advise on the appropriate use of preventive and acute medications, and help
    Identify and address medication overuse headache (MOH) if present.

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

What we do not offer

  • We do not prescribe opioids or pregabalin, as per local prescribing policy
  • We do not provide surgical or hospital-based neurology services
  • We do not offer emergency headache care