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Chronic daily headaches
By Mayo Clinic staffMayo Clinic Health Manager
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Definition
Most people have headaches from time to time. But if you have a headache more days than not, you may be experiencing a variety of head pain known as chronic daily headaches.
An estimated 3 percent to 5 percent of adults worldwide experience chronic daily headaches. The most common type of chronic daily headaches is divided into four subtypes:
- Chronic migraine
- Chronic tension-type headache
- New daily persistent headache
- Hemicrania continua
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.
Symptoms
By definition, chronic daily headaches must occur at least 15 days a month, for more than three months. The signs and symptoms vary depending on the specific subtype:
Chronic migraine
- Usually evolves from episodic migraine without aura
- Includes at least two of the following — affects only one side of your head, pulsating or throbbing pain, moderate to severe intensity, aggravated by physical activity
- Includes at least one of the following — nausea or vomiting, sensitivity to light and sound
Chronic tension-type headache
- Usually evolves from episodic tension-type headaches
- Typically hurts on both sides of your head
- Mild to moderate pain, often described as pressing or tightening
- May include mild nausea or sensitivity to light or sound
New daily persistent headache
- Starts suddenly and occurs daily within three days of onset
- Hurts on both sides of your head
- Feels like a tightening or pressing sensation, not throbbing
- Mild to moderate intensity
- Sometimes includes one of the following — mild nausea, sensitivity to sound or sensitivity to light
Hemicrania continua
- Hurts on only one side of the head and pain never shifts sides
- Daily and consistent, with no pain-free periods
- Moderate intensity, interspersed with brief instances of severe pain
- Includes at least one of the following — tearing or redness of the eye on the affected side, nasal congestion or runny nose, swelling or drooping of the eyelid
Causes
The causes of chronic daily headaches are not well understood. Some may be caused by various underlying diseases or conditions, including:
- Inflammation or other problems with the blood vessels in and around the brain
- Infections, such as meningitis
- Intracranial pressure that's either too high or too low
- Pinched nerves in the neck
- Brain tumor
- Traumatic brain injury
In most cases, however, chronic daily headaches don't have an underlying physical cause. They may occur if you develop a heightened response to pain signals or if the part of your brain that suppresses pain signals isn't working properly.
Many people who have chronic daily headaches are actually experiencing a rebound effect from taking pain medication too frequently. If you are taking pain medications — even over-the-counter analgesics — more than two days a week, you're at risk of developing rebound headaches.
Risk factors
Chronic daily headaches are more common in women than in men. Various factors may increase the risk of developing chronic daily headaches, including:
- Anxiety
- Depression
- Sleep disturbances
- Obesity
- Snoring
- Overuse of caffeine
- Overuse of pain medication
When to seek medical advice
Occasional headaches are common. But it's important to take headaches seriously. Consult your doctor if:
- You usually have three or more headaches a week
- You take a pain reliever for your headaches every day or almost every day
- You need more than the recommended dose of over-the-counter pain remedies to relieve your headaches
- Your headache pattern changes
- Your headaches are getting worse
Seek prompt medical care if your headache:
- Is sudden and severe
- Accompanies a fever, stiff neck, rash, confusion, seizure, double vision, weakness, numbness or difficulty speaking
- Follows a head injury
- Gets worse despite rest and pain medication
Tests and diagnosis
The doctor will ask a series of questions about your headaches, including when they started and what they feel like. Be sure to list all the medications you're taking, including the doses and frequency.
Your doctor will probably do a physical exam to check for signs of illness, infection or neurological problems. If the cause of your headaches remains uncertain, you may need blood or urine tests to identify any underlying medical conditions. Sometimes imaging studies — such as an X-ray, CT or MRI scans — are recommended.
Complications
If you have chronic daily headaches, you're also more likely to experience depression, anxiety, sleep disturbances, and other psychological and physical problems.
Treatments and drugs
Treatment for any underlying diseases or conditions often stops chronic daily headaches. When no underlying diseases or conditions are present, treatment focuses on preventing the pain before it starts.
Specific prevention strategies vary, depending on which type of headache you have and on whether medication overuse is contributing to these headaches. If you're taking pain relievers more than two days a week, the first step in treatment may be to stop using these drugs. When you're ready to begin preventive therapy, your doctor may recommend:
- Antidepressants. Tricyclic antidepressants — including amitriptyline and nortriptyline (Aventyl, Pamelor) — are the most common preventive medications for all types of chronic daily headaches except hemicrania continua. These medications can also help treat the depression, anxiety and sleep disturbances that often accompany chronic daily headaches. Another antidepressant — such as the selective serotonin reuptake inhibitor (SSRI) fluoxetine (Prozac) — may occasionally be an effective alternative for some people.
- Beta blockers. These drugs, commonly used to treat high blood pressure, are also a mainstay for preventing episodic migraines. Beta blockers include atenolol (Tenormin), metoprolol (Lopressor, Toprol), nadolol (Corgard) and propranolol (Inderal). Sometimes beta blockers are prescribed in combination with antidepressants for better results.
- Anti-seizure medications. Some anti-seizure drugs seem to prevent migraines. Now these medications may be used to prevent chronic daily headaches as well. Options may include divalproex (Depakote), gabapentin (Neurontin) and topiramate (Topamax).
- NSAIDs. Nonsteroidal anti-inflammatory drugs — such as naproxen (Aleve, Anaprox), ketoprofen and mefenamic acid (Ponstel) — may be helpful, especially if you're going through withdrawal from other pain relievers. They may also be used periodically when the headache is more severe.
- Others. Injections of a local anesthetic around a nerve (nerve block) or injections of a numbing agent and corticosteroid at the point of pain (trigger point injections) are sometimes recommended for chronic daily headaches. Although their role needs to be better defined, botulinum toxin type A (Botox) injections provide relief for some people as well.
Unfortunately, some chronic daily headaches remain resistant to all medications.
Prevention
Taking good care of yourself can help prevent chronic daily headaches.
- Avoid headache triggers. If you're not sure what triggers your headaches, keep a headache diary. Include details about every headache. When did it start? What were you doing at the time? What did you eat that day? How did you sleep the night before? What's your stress level? How long did the headache last? What, if anything, provided relief? Eventually, you may begin to see a pattern — and be able to take steps to prevent future headaches.
- Get enough sleep. Go to bed and wake up at the same time every day — even on weekends. If you're not tired at bedtime, read or watch television until you become drowsy and fall asleep naturally.
- Don't skip meals. Start your day with a healthy breakfast. Eat lunch and dinner at about the same time every day. Avoid any food or drinks, such as those containing caffeine, that seem to trigger headaches.
- Exercise regularly. Physical activity causes your body to release chemicals that block pain signals to your brain. With your doctor's OK, choose activities you enjoy — such as walking, swimming or cycling. To avoid injury, start slowly.
- Stop smoking. Smoking can trigger chronic migraine and chronic tension-type headaches. Higher levels of nicotine are also associated with increased anxiety and depression.
- Reduce stress. Get organized. Simplify your schedule. Plan ahead. Stay positive.
- Relax. Try yoga, meditation or relaxation exercises. Set aside time to slow down. Listen to music, read a book or take a hot bath.
Coping and support
Chronic daily headaches can interfere with your job, your relationships and your quality of life. But you can 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. Set aside time for your loved ones — and yourself — every day.
- 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 focused on your headaches.
- Check out support groups. When your head is throbbing, companionship may be the last thing on your mind — but perhaps it's just what you need. A support group can put you face to face with people who share your physical symptoms and emotional responses. You may learn useful coping strategies — or help others by sharing some of your own.
- Consider counseling. A counselor or therapist can help you manage stress and maintain your emotional balance. Through therapy, you can learn to change behavior that's not good for you and reinforce behavior that's helping you manage your headaches.
Alternative medicine
For many people, complementary or alternative therapies offer welcome 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 to promote the release of natural painkillers and other chemicals in the central nervous system. There is some evidence that it can help control headaches and other conditions that cause chronic pain.
- Biofeedback. With this relaxation technique, you can learn to control headaches by producing changes in bodily responses such as muscle tension, heart rate and skin temperature.
- Meditation. During meditation, you focus on a simple activity, such as breathing or repeating a single word or phrase. The practice creates a deeply restful state in which your breathing slows and your muscles relax — which can help you manage pain and reduce the stress that can trigger or worsen a headache.
- Massage. Massage can reduce stress, relieve tension and promote relaxation. Although its value as a headache treatment hasn't been determined, massage may be particularly helpful if you have tight, tender muscles in the back of your head, neck and shoulders.
- Herbs, vitamins and minerals. Some dietary supplements — including magnesium, feverfew and butterbur — seem to help prevent or relieve some types of headaches, but there's only modest scientific support for these claims. If you're considering using supplements to treat headaches, check with your doctor. Some supplements may interfere with the effectiveness of prescription or over-the-counter drugs or have other harmful effects.
- Chiropractic care. Spinal manipulation can effectively treat some types of pain, but studies don't support claims that chiropractic care relieves headaches. Chiropractic manipulation of the neck has been associated with injury to the blood vessels supplying the brain. Rarely, this may cause a stroke.
If you'd like to try a complementary or alternative therapy, discuss the risks and benefits with your doctor.
