Chronic Daily Headache

A 36-year-old woman with a long history of catamenial migraines had had a headache almost every day for a year. The background headache was mild, but it became severe and incapacitating at least twice a week, interfering with work and sleep. She took six to eight tablets containing a combination of aspirin, acetaminophen, and caffeine per day, with minimal relief. She did not have fever, weight loss, diplopia, or tinnitus. Her headaches were not exacerbated by a Valsalva maneuver or positional change. Her physical examination was normal. How should she be evaluated and treated?