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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 a variety of head pain known as 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 chronic daily headaches.

Symptoms Causes Risk factors Complications Prevention

By definition, chronic daily headaches must occur 15 days or more a month, for at least three months. And to be considered true (primary) chronic daily headaches, they must also not be the result of another condition.

Chronic daily headaches are classified by how long they last — more than four hours or less than four hours. The longer lasting headaches are more common and addressed here. They're divided into four types:

  • Chronic migraine
  • Chronic tension-type headache
  • New daily persistent headache
  • Hemicrania continua

Chronic migraine

These headaches evolve from episodic migraine without aura. To be diagnosed with chronic migraine, you must have headaches — migraine, tension-type or both — 15 days or more a month, for at least three months. In addition, on eight or more days a month for at least three months, you must experience the following symptoms.

Your headaches have at least two of the following characteristics:

  • Affect only one side of your head
  • Cause 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

Alternatively, if your headaches respond to triptan medications or ergot medications taken in anticipation of these symptoms — on eight or more days a month, for at least three months — they're also considered chronic migraines.

Chronic tension-type headache

These headaches evolve from episodic tension-type headaches. They may last hours or be constant.

Chronic tension-type headaches have at least two of the following characteristics:

  • Hurt on 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

In addition, they cause no more than one of the following:

  • Sensitivity to light or sound
  • Nausea (mild only)

New daily persistent headache

These headaches become constant within a few days of the moment you have your first headache.

New daily persistent headaches have at least two of the following characteristics:

  • Hurt on 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

In addition, they cause no more than one of the following:

  • Sensitivity to light or sound
  • Nausea (mild only)

Hemicrania continua

These headaches cause pain on only one side of your head that doesn't shift sides. They also:

  • Are daily and continuous with no pain-free periods
  • Cause moderate pain but 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 cause at least one of the following:

  • Tearing or redness of the eye on the affected side
  • Nasal congestion or runny nose
  • Drooping of the eyelid or constriction of the pupil

When to see a doctor

Occasional headaches are common. But it's important to take headaches seriously. Consult your doctor if:

  • You usually have two 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, 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. Some possible factors may include:

  • You've developed a heightened response to pain signals.
  • The part of your brain that suppresses pain signals isn't working properly.

Other frequent headaches may be caused by various underlying diseases or conditions, including:

  • 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

Many people who have frequent headaches are actually experiencing a rebound effect from taking pain medication too often. If you're taking pain medications — even over-the-counter analgesics — more than three days a week (or nine days a month), you're at risk of developing rebound headaches.

Various factors are associated with developing frequent headaches, including:

  • Anxiety
  • Depression
  • Sleep disturbances
  • Obesity
  • Snoring
  • Overuse of caffeine
  • Overuse of pain medication
  • Regular use of physical postures that put a strain on your head or neck

If you have chronic daily headaches, you're also more likely to experience depression, anxiety, sleep disturbances, and other psychological and physical problems.

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 was 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.
  • Avoid medication overuse. Taking headache medications, including over-the-counter medications, more than twice a week can actually increase the severity and frequency of your headaches. If you are taking medication too often, it is important to consult your doctor about how best 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. 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. Regular aerobic physical activity can improve your physical and mental well-being. Exercise also helps 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. Most headaches caused by stress end when the period of stress is over.
  • Relax. Try yoga, meditation or relaxation exercises. Set aside time to slow down. Listen to music, read a book or take a hot bath.
  • Reduce your 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 better yet, eliminate caffeine from your diet.
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