Chronic daily headache: how to manage it?

The role of daily analgesic use (also called abuse) in chronic daily headache (CDH) for the maintenance of chronic headache is discussed. The comprehension of the underlying mechanisms of actions is lacking mainly because of the absence of animal models. The abuse should be considered as a compulsive behavior rather than linked to the type of analgesic used and related both to “how” the drug is taken and to “what” drug is used. Moreover, there is no evidence of addictive personality in these patients, and also predictive factors for the long-term outcomes are inconsistent. In the literature specific indications are lacking for the treatment to be performed in these patients. In conclusion, the main problem for these patients is to manage their headaches, and the aim of the therapy should be to enable patients to feel in control of their migraine rather than feel that migraine or analgesic drugs control them. Correspondence to L.A. Pini