Chronic daily headaches
Most people have headaches from time to time. But if you have a headache more days than not, you may be experiencing chronic daily headaches.
The incessant nature of chronic daily headaches makes them among the most disabling headaches. Aggressive initial treatment and steady, long-term management may reduce pain and lead to fewer headaches.
By definition, chronic daily headaches occur 15 days or more a month, for at least three months. True (primary) chronic daily headaches aren't caused by another condition.
There are short-lasting and long-lasting chronic daily headaches. Long-lasting last more than four hours. They include:
- Chronic migraine
- Chronic tension-type headache
- New daily persistent headache
- Hemicrania continua
This type typically occurs in people with a history of episodic migraines. On eight or more days a month for at least three months, migraines tend to have the following features:
- Affect one side or both sides of your head
- Have a pulsating, throbbing sensation
- Cause moderate to severe pain
- Are aggravated by routine physical activity
And they cause at least one of the following:
- Nausea, vomiting or both
- Sensitivity to light and sound
Chronic tension-type headache
These headaches tend to have the following features:
- Affects both sides of your head
- Cause mild to moderate pain
- Cause pain that feels pressing or tightening, but not pulsating
- Aren't aggravated by routine physical activity
Some people may have skull tenderness.
New daily persistent headache
These headaches come on suddenly, usually in people without a headache history. They become constant within three days of your first headache. They have at least two of the following characteristics:
- Usually affects both sides of your head
- Cause pain that feels like pressing or tightening, but not pulsating
- Cause mild to moderate pain
- Aren't aggravated by routine physical activity
- Affect only one side of your head
- Are daily and continuous with no pain-free periods
- Cause moderate pain with spikes of severe pain
- Respond to the prescription pain reliever indomethacin (Indocin)
- May sometimes become severe with development of migraine-like symptoms
In addition, hemicrania continua headaches are associated with at least one of the following:
- Tearing or redness of the eye on the affected side
- Nasal congestion or runny nose
- Drooping eyelid or pupil narrowing
- Sensation of restlessness
When to see a doctor
Occasional headaches are common, and usually require no medical attention. However, consult your doctor if:
- You usually have two or more headaches a week
- You take a pain reliever for your headaches most days
- You need more than the recommended dose of over-the-counter pain remedies to relieve your headaches
- Your headache pattern changes or your headaches worsen
- Your headaches are disabling
Seek prompt medical care if your headache:
- Is sudden and severe
- Accompanies a fever, stiff neck, confusion, seizure, double vision, weakness, numbness or difficulty speaking
- Follows a head injury
- Gets worse despite rest and pain medication
The causes of many chronic daily headaches aren't well-understood. True (primary) chronic daily headaches don't have an identifiable underlying cause.
Conditions that may cause non-primary chronic daily headaches include:
- Inflammation or other problems with the blood vessels in and around the brain, including stroke
- Infections, such as meningitis
- Intracranial pressure that's either too high or too low
- Brain tumor
- Traumatic brain injury
Medication overuse headache
This type of headache usually develops in people who have an episodic headache disorder, usually migraine or tension-type, and take too much pain medication. If you're taking pain medications — even over-the-counter analgesics — more than two days a week (or nine days a month), you're at risk of developing rebound headaches.
Factors associated with developing frequent headaches include:
- Female sex
- Sleep disturbances
- Overuse of caffeine
- Overuse of headache medication
- Other chronic pain conditions
If you have chronic daily headaches, you're also more likely to have depression, anxiety, sleep disturbances, and other psychological and physical problems.
Preparing for your appointment
You're likely to start by seeing your family doctor or a general practitioner. However, you may be referred to a headache specialist.
Here's some information to help you get ready for your appointment.
What you can do
- Be aware of pre-appointment restrictions. When you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet.
- Keep a headache journal, which should include when each headache occurred, how long it lasted, how intense it was, what you were doing immediately before the headache started, and anything else notable about the headache.
- Write down your symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Write down key personal information, including major stresses or recent life changes.
- List all medications, vitamins or supplements you're taking, including doses and frequency of use. Include medications used previously.
- Take a family member or friend along, if possible. Someone who accompanies you can help you remember information.
- Write down a list of questions to ask your doctor.
For chronic headaches, some basic questions to ask your doctor include:
- What's the likely cause of my headaches?
- Are there other possible causes?
- What tests do I need?
- Is my condition likely temporary or chronic?
- What's the best course of action?
- What are the alternatives to the primary approach you're suggesting?
- I have other health conditions. How can I best manage them together?
- Should I see a specialist?
- Is there a generic alternative to the medicine you're prescribing?
- Are there printed materials that I can have? What websites do you recommend?
Don't hesitate to ask other questions you have.
What to expect from your doctor
Examples of questions your doctor may ask, include:
- When did your headaches begin?
- Have your headaches been continuous or occasional?
- How severe are your headaches?
- What, if anything, seems to improve your headaches?
- What, if anything, appears to worsen your headaches?
What you can do in the meantime
To ease your headache pain until you see your doctor, you might:
- Avoid activities that worsen your headaches.
- Try over-the-counter pain-relief medications — such as naproxen sodium (Aleve) and ibuprofen (Advil, Motrin IB, others). To avoid rebound headaches, don't take these more than three times a week.
Tests and diagnosis
Your doctor will likely examine you for signs of illness, infection or neurological problems. He or she will ask about your headache history.
If the cause of your headaches remains uncertain, your doctor may order imaging tests, such as a CT scan or MRI, to look for an underlying medical condition.
Treatments and drugs
Treatment for an underlying condition often stops frequent headaches. When no other condition is discerned, treatment focuses on preventing pain.
Prevention strategies vary, depending on the type of headache you have and whether medication overuse is contributing to these headaches. If you're taking pain relievers more than three days a week, the first step may be to wean yourself off these drugs with your doctor's guidance.
When you're ready to begin preventive therapy, your doctor may recommend:
Antidepressants. Tricyclic antidepressants — such as nortriptyline (Pamelor) — can be used to treat chronic headaches. These medications can also help treat the depression, anxiety and sleep disturbances that often accompany chronic daily headaches.
Other antidepressants, such as the selective serotonin reuptake inhibitor (SSRI) fluoxetine (Prozac, Sarafem, others), may help in treating depression and anxiety, but have not been shown to be more effective than placebo for headaches.
- Beta blockers. These drugs, commonly used to treat high blood pressure, are also a mainstay for preventing episodic migraines. Some beta blockers include atenolol (Tenormin), metoprolol (Lopressor, Toprol-XL) and propranolol (Inderal, Innopran XL).
- Anti-seizure medications. Some anti-seizure drugs seem to prevent migraines and may be used to prevent chronic daily headaches, as well. Options include topiramate (Topamax, Qudexy XR, others), divalproex sodium (Depakote) and gabapentin (Neurontin, Gralise).
- NSAIDs. Prescription nonsteroidal anti-inflammatory drugs — such as naproxen sodium (Anaprox, Naprelan) — may be helpful, especially if you're withdrawing from other pain relievers. They may also be used periodically when the headache is more severe.
- Botulinum toxin. OnabotulinumtoxinA (Botox) injections provide relief for some people and may be a viable option for people who don't tolerate daily medication well.
Unfortunately, some chronic daily headaches remain resistant to all medications.
For many people, complementary or alternative therapies offer relief from headache pain. It's important to be cautious, however. Not all complementary or alternative therapies have been studied as headache treatments, and others need further research.
- Acupuncture. This ancient technique uses hair-thin needles inserted into several areas of your skin at defined points. While the results are mixed, some studies have shown that acupuncture helps reduce the frequency and intensity of chronic headaches.
- Biofeedback. You might be able to control headaches by becoming more aware of and then changing certain bodily responses, such as muscle tension, heart rate and skin temperature.
- Massage. Massage can reduce stress, relieve pain and promote relaxation. Although its value as a headache treatment hasn't been determined, massage may be particularly helpful if you have tight muscles in the back of your head, neck and shoulders.
Herbs, vitamins and minerals. Some evidence exists that the herbs feverfew and butterbur may prevent migraines or reduce their severity. A high dose of riboflavin (vitamin B-2) also may reduce migraine headaches.
Coenzyme Q10 supplements may be helpful in some individuals. And oral magnesium sulfate supplements may reduce the frequency of headaches in some people, although studies don't all agree. Ask your doctor if these treatments are right for you. Don't use riboflavin (vitamin B-2), feverfew or butterbur if you're pregnant.
- Electrical stimulation of the occipital nerve. A small battery-powered electrode is surgically implanted near the occipital nerve, which is at the base of your neck. The electrode sends continuous energy pulses to the nerve to ease pain. This approach is considered investigational.
Before trying complementary or alternative therapy, discuss the risks and benefits with your doctor.
Coping and support
Chronic daily headaches can interfere with your job, your relationships and your quality of life. Here are suggestions to help you cope with the challenges.
- Take control. Commit yourself to living a full, satisfying life. Work with your doctor to develop a treatment plan that works for you. Take good care of yourself. Do things that lift your spirits.
- Seek understanding. Don't expect friends and loved ones to instinctively know what's best for you. Ask for what you need, whether it's time alone or less attention paid to your headaches.
- Check out support groups. You may find it useful to talk to other people who have painful headaches.
- Consider counseling. A counselor or therapist offers support and can help you manage stress. Your therapist can also help you understand the psychological effects of your headache pain. In addition, there's evidence that cognitive behavioral therapy can reduce headache frequency and severity.
Taking care of yourself might help ease chronic daily headaches.
- Avoid headache triggers. Keeping a headache diary can help you determine what triggers your headaches so that you can avoid the triggers. Include details about every headache, such as when it started, what you were doing at the time and how long it lasted.
- Avoid medication overuse. Taking headache medications, including over-the-counter medications, more than twice a week can increase the severity and frequency of your headaches. Consult your doctor about how to wean yourself off the medication because there can be serious side effects if done improperly.
- Get enough sleep. The average adult needs seven to eight hours of sleep a night. It's best to go to bed and wake up at regular times, as well.
- Don't skip meals. Eat healthy meals at about the same times daily. Avoid food or drinks, such as those containing caffeine, that seem to trigger headaches. Lose weight if you're obese.
- Exercise regularly. Regular aerobic physical activity can improve your physical and mental well-being and reduce stress. With your doctor's OK, choose activities you enjoy — such as walking, swimming or cycling. To avoid injury, start slowly.
- Reduce stress. Stress is a common trigger of chronic headaches. Get organized. Simplify your schedule. Plan ahead. Stay positive. Try stress-reduction techniques, such as yoga, tai chi or meditation.
- Reduce caffeine. While some headache medications include caffeine because it can be beneficial in reducing headache pain, it can also aggravate headaches. Try to minimize or eliminate caffeine from your diet.
Last updated: March 10th, 2015