Abstract

Chronic cephalea is defined as a headache that occurs 15 or more days a month and for more than 3 months. Chronic migraine, in addition to this frequency of headaches, has migraine characteristics. Prophylactic treatment is based on the use of amitriptyline, propranolol, antiepileptic drugs, verapamil and/or tizanidine. Chronic tension cephalea involves oppressive pain, mild phonophobia or photophobia but with no clear general malaise. The symptoms improve with amitriptyline, mirtazapine, venlafaxine, antiepileptic drugs and tizanidine. Chronic neuralgiform cephalea lasts more than a year without periods of remission or with periods of remission that last less than a month. This condition includes the following forms: cephalea in chronic clusters, which is treated with verapamil, lithium carbonate, valproic acid, steroids or topiramate;chronic paroxysmal hemicrania, which is treated with indomethacin; chronic SUNCT (short-lasting unilateral neuralgiform headache with conjunctival injection and tearing), which is treated with antiepileptic drugs, lithium and steroids; continuous paroxysmal hemicrania (characterized by unilateral pain, conjunctival injection, autonomic symptoms, miosis and unilateral palpebral ptosis and restlessness), which responds well to indomethacin.

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