Chronic Daily Headaches

Having an occasional headache is normal. However, if headaches last longer than normal, you could be having a condition called chronic daily headaches.

Chronic pain in your head can affect your quality of life.

Treatment involves use of various medications and measures to prevent the triggers. 

The main symptoms of chronic daily headaches are headaches for 15 or more days a month, for at least three months.

True (primary) chronic daily headaches occur on their own and no underlying cause can be identified.

Chronic daily headaches can be short-lasting or long-lasting with the latter lasting more than four hours. The long-lasting type includes:

Chronic migraine

Associated with a history of episodic migraine, this type affects you 8 or more days a month for at least 3 months and presents with following characteristics:

• Pounding and pumping pain in one side or both sides of your head
• Pain can be moderate or severe
• Pain worsened by normal physical activity
• Pain associated with at least one of the following: Nausea, vomiting or both, sensitivity to light and sound

Chronic tension-type headache presents with following features

• Pain in both sides of your head
• Pain can be mild to moderate pain
• Pain can be pressing or tightening, but not pulsating
• Pain not aggravated by normal physical activity
• Skull tenderness, less common

New daily persistent headache

This type occurs suddenly and is usually not associated with headache history. Steady pain occurs within three days of your first headache.

This type has at least two of the following features:

• Usually, pain in both sides of your head
• Pain can be mild to moderate pain
• Pain can be pressing or tightening, but not pulsating
• Pain not aggravated by normal physical activity

Hemicrania continua presents with the following features

• Pain in one side of your head
• Occur daily and continuously with no pain-free periods
• Pain is moderate with spikes of severe pain
• Pain can be managed by prescription pain reliever indomethacin
• Pain can be severe with symptoms resembling that of a migraine

Also, this type has at least one of the following

• Eye on the affected side becomes red or watery
• Nasal blockage or runny nose
• Abnormally low upper eyelid (drooping eyelid) or pupil narrowingAgitation 

When to see a doctor?

It’s normal to have occasional headaches, which need no medical attention. Talk to your doctor if headaches:

• occur two or more days a week
• require pain medication for most days
• require higher dose of over-the-counter pain killer
• change pattern or aggravate
• are debilitating 

Seek immediate medical care if you have:

• sudden and severe headache
• headache associated with
  • a fever,
  • stiff neck,
  • confusion,
  • seizure, double vision,
  • weakness,
  • numbness
  • or difficulty speaking
• headache after a head injury
• headache that doesn’t improve with rest and pain medication

In most cases, the cause of chronic daily headaches is unknown. True (primary) chronic daily headaches may occur without a cause.

Some probable causes of non-primary chronic daily headaches include:

• Conditions that affect blood vessels in and around the brain, such as stroke or inflammation
• Infections, such as meningitis
• Too high or too low pressure inside your skull (Intracranial pressure)
• Brain tumor
• Traumatic brain injury

Headache caused by medication overuse headache

Excessive use of pain medication for migraine or tension-type can cause chronic daily headaches.

The risk increases if you're taking pain medications, including over-the-counter analgesics, more than two days a week.

The diagnosis of chronic daily headaches begins with examination to look for signs of illness, infection or neurological problems and a conversation on your headache history.

If no cause is identified, further tests like a CT scan or MRI may be recommended to detect any underlying medical condition.

If you experience any of the signs that worry you, visit your doctor who may refer you to a headache specialist.

How to prepare yourself for the visit?

Getting prepared for the visit can optimize the therapy and help make the visit more fruitful.

Keep a record of your headache. Mention the occurrence, duration and intensity of pain. Make a list of all the symptoms. Write down your key medical information. Write down the names of all your medications, vitamins or supplements. Ask a friend or a family member to accompany you during the visit.

Make a list of the questions to ask your doctor

Some typical questions can be:

• What could be the most probable cause of my headaches?
• What are the tests needed?
• How long will my condition last?
• How can I best manage my condition?
• Should I see a specialist? 

What your doctor wants to know?

A clear talk with your doctor can optimize the therapy and improve the outcomes. Prepare yourself to answer some essential questions from your doctor.

Your doctor might ask you typical questions like:

• When did you start having headaches and how severe are they?
• Do your headaches occur continuously or occasionally?
• Does anything improve or aggravate your headaches? 

What you can do in the meantime 

You may do these until you see your doctor:

• Avoid triggers
• Try over-the-counter pain medications such as naproxen and ibuprofen. Remember not to take these more than three times a week.

Treatment for chronic daily headaches focuses on treating the underlying cause, if any, and preventing pain.

Preventive measures depend on headache type and presence of obvious cause like medication overuse. If medication overuse is identified as the cause for your headaches, your doctor can suggest you to minimize the dose.

Other preventive measures include:

Antidepressants

Depression treating drug nortriptyline can help to manage chronic headaches. In addition, it also treats depression, anxiety and sleep problems associated with chronic daily headaches. Other antidepressants, such as the selective serotonin reuptake inhibitor (SSRI) fluoxetine are not effective in treating headaches.

Beta blockers

Pressure lowering drugs such as atenolol, metoprolol and propranolol are a major preventive treatment for episodic migraines.

Anti-seizure medications

Anti-convulsants like topiramate, divalproex sodium and gabapentin are useful in preventing migraines and chronic daily headaches.

NSAIDs

Prescription nonsteroidal anti-inflammatory drugs such as naproxen can be used when other pain medications are ineffective. In severe cases, they may also be used periodically.

Botulinum toxin

OnabotulinumtoxinA (Botox) injections help to relieve pain and can be used in people who cannot take medications daily.

Unfortunately, there are certain types of chronic daily headaches which do not respond to any of the medications.

Here are some preventive measures to ease chronic daily headaches.

• Avoid headache triggers: Keep a record of your headache including its occurrence, duration and intensity. This can help you to avoid the triggers.

• Do not “overuse” pain medication: Do not take any pain medication more than twice a week. Do not discontinue the medication abruptly, consult your doctor before lowering the dose or discontinuing any medication.

• Sleep well: Maintain a sleep habit and sleep for at least 7 hours.

• Don't “miss” meals: Follow a healthy eating habit. Stay away from caffeine.

• Lose weight if you're obese.

• Exercise regularly to reduce stress and maintain a healthy body and mind. Talk to your doctor before starting any exercise. 

• Learn stress management skills like deep breathing techniques. 

• Look at the brighter side: Positivity can make you stress-free. You may also try yoga, tai chi or meditation. 

• Limit caffeine intake: Caffeine can aggravate headaches.

Complementary or alternative remedies may be useful to relieve pain but start any such therapy only after consulting with your doctor.

Acupuncture

Acupuncture may be useful in reducing the frequency and intensity of chronic headaches.

Biofeedback: This therapy can teach you techniques to alter your bodily responses, such as muscle tension, heart rate and skin temperature.

Massage

Gentle massage may be helpful in relaxing muscles in the back of your head, neck and shoulders.

Herbs, vitamins and minerals

Herbs feverfew and butterbur, high dose of riboflavin (vitamin B-2) and coenzyme Q10 supplements may help to prevent headache or reduce the severity. Do not take any such supplement without consulting your doctor. Avoid riboflavin (vitamin B-2), feverfew or butterbur if you're pregnant.

Electrical stimulation of the occipital nerve

The nerve at the base of your neck, occipital nerve, is stimulated by pulses from a small battery-powered electrode. This approach is still under study.

"DO NOT START ANY SUCH THERAPY WITHOUT CONSULTING YOUR DOCTOR"

Lifestyle modifications are necessary in order to cope with chronic daily headaches.

Chronic daily headaches can be debilitating. It can wreak havoc on your life as a whole.

We have some suggestions to help you

• Keep pain under control.
• Live a full, satisfying life. 
• Collaborate with your doctor to find what works for you. 
• Take care of yourself. 
• Lift your moods with some interesting activities. 
• Keep your expectations low but not very low. 
• Join a support group: Find one in your community or online. 
• Talk to a counselor: A counselor can help you live through pain.

There are several risks and complications associated with chronic daily headaches.

Risks

• Female 
• Anxiety 
• Depression 
• Sleep disturbances 
• Obesity 
• Snoring 
• Excessive caffeine consumption 
• Pain medication overuse 
• Other chronic pain conditions

Complications

Chronic daily headaches can make you more prone to developing

• depression,
• anxiety,
• sleep disturbances, and other psychological
• and physical problems.