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

Marcelo E. Bigal, Richard B. Lipton

Research output: Contribution to journalReview articlepeer-review

47 Scopus citations


Chronic 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 ≥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.

Original languageEnglish (US)
Pages (from-to)263-272
Number of pages10
JournalJournal of Headache and Pain
Issue number5
StatePublished - Oct 2007


  • Chronic daily headache
  • Differential diagnosis
  • Strategy

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine


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