What is chronic headache?
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.
How common is chronic headache?
Chronic headache is extremely common. It commonly affects more females than males. It can affect patients at any age. It can be managed by reducing your risk factors. Please discuss with your doctor for further information.
What are the symptoms of chronic headache?
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
There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.
When should I see my doctor?
You should contact your doctor if you have any of the following:
- 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
What causes chronic headache?
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.
What increases my risk for chronic headache?
There are many risk factors for chronic headache, such as:
- Female sex
- Sleep disturbances
- Overuse of caffeine
- Overuse of headache medication
- Other chronic pain conditions
Diagnosis & Treatment
The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.
How is chronic headache diagnosed?
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.
How is chronic headache treated?
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:
- 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).
- 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.
Lifestyle changes & Home remedies
What are some lifestyle changes or home remedies that can help me manage chronic headache?
The following lifestyles and home remedies might help you cope with chronic headache:
- 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.
- 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 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.
If you have any questions, please consult with your doctor to better understand the best solution for you.
Hello Health Group does not provide medical advice, diagnosis or treatment.
Headache Basics. http://www.webmd.com/migraines-headaches/guide/migraines-headaches-basics#1. Accessed 26 Feb 2017.
Chronic daily headaches. http://www.mayoclinic.org/diseases-conditions/chronic-daily-headaches/basics/definition/con-20025386. Accessed 26 Feb 2017.
Review Date: March 10, 2017 | Last Modified: March 10, 2017