title: Update of Inpatient Treatment for Refractory Chronic Daily Headache.
abstract: Chronic daily headache (CDH) is a group of headache disorders, in which headaches occur daily or near-daily (>15 days per month) and last for more than 3 months. Important CDH subtypes include chronic migraine, chronic tension-type headache, hemicrania continua, and new daily persistent headache. Other headaches with shorter durations (<4 h/day) are usually not included in CDH. Common comorbidities of CDH are medication overuse headache and various psychiatric disorders, such as depression and anxiety. Indications of inpatient treatment for CDH patients include poor responses to outpatient management, need for detoxification for overuse of specific medications (particularly opioids and barbiturates), and severe psychiatric comorbidities. Inpatient treatment usually involves stopping acute pain, preventing future attacks, and detoxifying medication overuse if present. Multidisciplinary integrated care that includes medical staff from different disciplines (e.g., psychiatry, clinical psychology, and physical therapy) has been recommended. The outcomes of inpatient treatment are satisfactory in terms of decreasing headache intensity or frequency, withdrawal from medication overuse, reducing disability, and improving life quality, although long-term relapse is not uncommon. In conclusion, inpatient treatment may be useful for select patients with refractory CDH and should be incorporated in a holistic headache care program.
authors.affiliation: Department of Neurology, National Yang-Ming University, School of Medicine, Taipei, 112, Taiwan.|Section of Neurology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei, 220, Taiwan.
authors.forename: Tzu-Hsien
authors.initials: TH
authors.lastname: Lai
authors.affiliation: Department of Neurology, National Yang-Ming University, School of Medicine, Taipei, 112, Taiwan. sjwang@vghtpe.gov.tw.|Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Taipei, 112, Taiwan. sjwang@vghtpe.gov.tw.
authors.forename: Shuu-Jiun
authors.initials: SJ
authors.lastname: Wang
mesh_terms: D000818:Animals; D002908:Chronic Disease; D006261:Headache / Q000628:therapy*; D020773:Headache Disorders / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D008881:Migraine Disorders / Q000628:therapy*; D012008:Recurrence
keywords: Chronic daily headache; Chronic migraine; Inpatient; Medication overuse