Is chronic daily headache a useful diagnosis?

The widely used term chronic daily headache is a common denominator for a chronic headache with a daily occurrence but is not included in the former and in the revised versions of the IHS classification system. We discuss the pros and cons for the use of the term chronic daily headache, and describe some of the problematic aspects in patients with chronic headaches. We find that the term should only be used as an unspecific, clinical working description and never as a final diagnosis due to lack of specificity. Most patients in specialized headache clinics suffer from several different primary and secondary headaches at the same time and deserve a careful characterization before a rational therapy can be initiated. In particular, it is of utmost importance to identify and treat coexisting medication overuse since such overuse may distort the clinical phenotypic presentation and render various prophylactic strategies ineffective. As the prognosis of medication overuse headache usually is favorable, identification of drug overuse is mandatory. The use of a wastebasket diagnosis such as chronic daily headache may obscure the precise headache diagnosis leading to an unsatisfactory treatment strategy and should therefore be avoided.