There is a drug-dependent rhythmicity of headaches. Early morning headaches are frequent. There is evidence of tolerance to analgesics over time. Increase in severity and frequency of headache attacks. Spontaneous improvement is associated with medication withdrawal.
Prophylactic medications are ineffective.
More than 20 headache days per month. Daily headache duration exceeding 10 hours. Patterns of symptomatic drug use in patients with chronic daily headaches are summarized in Table 11. Modified with permission from Mathew NT, Kurman R, Perez F. 35 Drug misuse is also a concern in patients suspected of seeking care from multiple physicians in order to get multiple prescriptions. A new patient with in-depth knowledge of a particular medication and its strengths and weaknesses.