Chronic Daily Headache Management : Mnemonics

Chronic Daily Headache Management Mnemonic  :

• • D: Diagnose any secondary headache and treat that problem 
  • I: Identify the underlying cause that triggers worsening of a primary headache
  • A: Amitriptyline or nortriptyline at doses up to 1 mg/kg are very useful for CDH arising from migraine or tension-type headache, or where the secondary cause has activated the underlying primary headache
  • G: Give tricyclics in low doses (10-25 mg daily) and 12 h before the expected time of awakening to avoid excessive morning sleepiness
  • N: Newer medications like topiramate, valproate, propranolol, flunarizine, candesartan, and CGRP pathway monoclonal antibodies or gepants-CGRP receptor antagonists are also useful when the underlying issue is migraine
  • O: Overall, diagnosis of the headache type will guide therapy
  • S: Secondary headache should be ruled out before treating primary headache
  • E: Expect a challenge when secondary cause triggers worsening of primary headache

Mnemonic: ” DIAGNOSE “