What are the main types of chronic daily headaches. How can you identify potential triggers for chronic headaches. When should you seek medical attention for persistent headaches. What lifestyle changes can help prevent or reduce chronic headaches.

Understanding Chronic Daily Headaches: More Than Just a Nuisance

Chronic daily headaches are a debilitating condition that affects many individuals, causing pain and discomfort for 15 or more days per month, persisting for at least three months. Unlike occasional headaches that most people experience, chronic daily headaches can significantly impact one’s quality of life and daily functioning.

Are chronic daily headaches considered normal? Experiencing headaches on a daily basis is not typical and should be addressed by a healthcare professional. While occasional headaches are common, persistent and frequent headaches may indicate an underlying condition that requires medical attention.

The Four Main Types of Chronic Daily Headaches

Chronic daily headaches can manifest in various forms, each with distinct characteristics. Understanding these types can help in proper diagnosis and treatment:

1. Chronic migraine headaches
2. Chronic tension headaches
3. New daily persistent headaches
4. Hemicrania continua

Chronic Migraine Headaches

Chronic migraine headaches are often characterized by:

• Throbbing sensation on one or both sides of the head
• Moderate to severe pain intensity
• Nausea and/or vomiting
• Sensitivity to light and sound

How do chronic migraines differ from episodic migraines? Chronic migraines occur on 15 or more days per month, while episodic migraines happen less frequently. The persistent nature of chronic migraines can make them particularly challenging to manage.

Chronic Tension Headaches

Chronic tension headaches typically present with:

• Bilateral pain (affecting both sides of the head)
• Mild to moderate pain intensity
• Pressing or tightening sensation (non-throbbing)

Can chronic tension headaches be mistaken for other conditions? Yes, chronic tension headaches may sometimes be confused with sinus headaches or other types of headaches. A proper medical evaluation is crucial for accurate diagnosis and appropriate treatment.

New Daily Persistent Headaches

New daily persistent headaches are characterized by:

• Sudden onset in individuals without a prior history of headaches
• Bilateral pain
• Pressing or tightening sensation
• Mild to moderate pain intensity

Why are new daily persistent headaches considered unique? These headaches are distinct due to their abrupt onset and continuous nature from the very beginning, often allowing individuals to pinpoint the exact date when their headaches started.

Hemicrania Continua

Hemicrania continua is a rare type of chronic daily headache characterized by:

• Continuous pain on one side of the head
• No pain-free periods
• Spikes of severe pain
• Responsiveness to the prescription drug Indocin
• Associated symptoms such as tearing, eye redness, nasal congestion, or eyelid drooping on the affected side

How is hemicrania continua diagnosed? Diagnosis often involves a trial of Indocin, as a positive response to this medication is considered a hallmark of the condition. However, a thorough medical evaluation is necessary to rule out other potential causes.

Unraveling the Mystery: Potential Causes of Chronic Headaches

The exact causes of chronic daily headaches remain largely unknown, but several factors and conditions have been associated with their occurrence:

• Blood vessel problems in and around the brain
• Strokes or reduced blood flow to the brain
• Infections, including meningitis
• Abnormal intracranial pressure (high or low)
• Brain tumors
• Traumatic brain injury
• Medication overuse

Is there a genetic component to chronic daily headaches? While research is ongoing, some studies suggest that genetic factors may play a role in susceptibility to certain types of chronic headaches, particularly migraines. However, environmental and lifestyle factors also significantly contribute to their development and persistence.

Preventive Strategies: Minimizing the Impact of Chronic Headaches

While the underlying causes of chronic daily headaches may be complex, there are several strategies that can help prevent or reduce their frequency and intensity:

Identifying and Avoiding Triggers

How can you identify your headache triggers? Keeping a detailed headache diary can be invaluable in recognizing patterns and potential triggers. Record information about your headaches, including:

• Timing and duration
• Pain intensity and location
• Associated symptoms
• Foods and beverages consumed
• Activities and environmental factors
• Sleep patterns
• Stress levels

By analyzing this information over time, you may be able to identify specific triggers and work on avoiding or managing them.

Proper Medication Management

Can overuse of headache medication worsen the problem? Yes, using headache medications more than twice a week can lead to medication overuse headaches, potentially increasing the frequency and severity of headaches. If you find yourself relying heavily on pain relievers, consult your healthcare provider about developing a more sustainable management plan.

Prioritizing Sleep Hygiene

How does sleep affect chronic headaches? Poor sleep quality or irregular sleep patterns can trigger or exacerbate headaches. Aim for 7-8 hours of quality sleep per night and maintain a consistent sleep schedule, even on weekends. If you struggle with sleep issues, consider consulting a sleep specialist.

Maintaining a Healthy Diet

What dietary habits can help manage chronic headaches? Regular, balanced meals are crucial. Skipping meals can trigger headaches in some individuals. Additionally, staying hydrated and identifying any food triggers (such as caffeine, alcohol, or certain additives) can be beneficial in managing chronic headaches.

Regular Exercise

How does exercise impact chronic headaches? Regular physical activity can help reduce stress, improve overall well-being, and potentially decrease headache frequency. However, it’s important to start slowly and consult with your healthcare provider, as intense exercise can trigger headaches in some individuals.

Stress Management

What stress reduction techniques are effective for managing chronic headaches? Practices such as yoga, tai chi, meditation, and deep breathing exercises can help manage stress, a common trigger for chronic headaches. Cognitive-behavioral therapy (CBT) may also be beneficial in developing coping strategies.

Caffeine Moderation

How does caffeine affect chronic headaches? Caffeine’s relationship with headaches is complex. While it can provide relief for some headaches, excessive or regular caffeine consumption can lead to dependency and withdrawal headaches. Gradually reducing caffeine intake may be helpful for some individuals with chronic headaches.

Recognizing When to Seek Medical Attention

While occasional headaches are common, certain situations warrant medical evaluation. Consider consulting a healthcare provider if you:

• Experience two or more headaches per week consistently
• Rely on pain relievers for headaches most days
• Require more than the recommended dose of over-the-counter medications for relief
• Notice changes in your headache patterns or worsening symptoms
• Find your headaches significantly impacting your daily life

When should you seek immediate medical care for a headache? Certain headache symptoms require urgent medical attention. Seek emergency care if your headache:

• Is sudden and severe (often described as a “thunderclap” headache)
• Is accompanied by fever, stiff neck, confusion, seizures, double vision, weakness, numbness, or speech difficulties
• Occurs following a head injury
• Worsens despite rest and pain medication

Advanced Treatment Options for Chronic Daily Headaches

When lifestyle modifications and over-the-counter treatments prove insufficient, healthcare providers may recommend more advanced treatment options for chronic daily headaches:

Preventive Medications

What types of preventive medications are used for chronic headaches? Several classes of medications may be prescribed to reduce the frequency and severity of chronic headaches:

• Antidepressants (e.g., amitriptyline, venlafaxine)
• Anti-seizure drugs (e.g., topiramate, valproic acid)
• Beta-blockers (e.g., propranolol, metoprolol)
• Calcium channel blockers (e.g., verapamil)
• CGRP antagonists (e.g., erenumab, fremanezumab)

The choice of medication depends on the specific type of headache, individual patient factors, and potential side effects.

Botulinum Toxin Injections

How effective are Botox injections for chronic migraines? Botulinum toxin (Botox) injections have shown significant efficacy in reducing the frequency and severity of chronic migraines in many patients. The treatment typically involves multiple injections around the head and neck every 12 weeks.

Nerve Blocks

What are nerve blocks, and how do they help with chronic headaches? Nerve blocks involve injecting anesthetic medications near specific nerves thought to be involved in headache pain. This can provide temporary relief and may be particularly useful for certain types of headaches, such as occipital neuralgia.

Neurostimulation Devices

How do neurostimulation devices work for chronic headaches? Various neurostimulation devices, such as transcutaneous electrical nerve stimulation (TENS) units or transcranial magnetic stimulation (TMS) devices, can modulate nerve activity and potentially reduce headache pain. These non-invasive options are becoming increasingly popular for headache management.

Cognitive Behavioral Therapy (CBT)

Can psychological interventions help with chronic headaches? Yes, CBT and other psychological interventions can be highly effective in managing chronic headaches. These approaches help patients develop coping strategies, manage stress, and address any underlying psychological factors contributing to their headaches.

The Role of Complementary and Alternative Medicine in Headache Management

Many individuals with chronic daily headaches explore complementary and alternative medicine (CAM) approaches to supplement conventional treatments:

Acupuncture

Is acupuncture effective for chronic headaches? Some studies suggest that acupuncture may be beneficial in reducing the frequency and intensity of chronic headaches, particularly tension-type headaches and migraines. However, more research is needed to fully understand its efficacy.

Herbal Supplements

What herbal supplements are commonly used for headache management? Several herbs have been traditionally used for headache relief, including:

• Feverfew
• Butterbur
• Ginger
• Magnesium

It’s crucial to consult with a healthcare provider before starting any herbal supplement regimen, as these can interact with medications and may have side effects.

Biofeedback

How does biofeedback help with chronic headaches? Biofeedback techniques teach individuals to control certain bodily processes that might help reduce headache pain. This may include learning to relax specific muscles or alter blood flow patterns. Some patients find this approach helpful in managing tension-type headaches and migraines.

The Importance of a Multidisciplinary Approach to Chronic Headache Management

Given the complex nature of chronic daily headaches, a multidisciplinary approach often yields the best results. This may involve collaboration between various healthcare professionals, including:

• Neurologists
• Pain specialists
• Primary care physicians
• Psychologists or psychiatrists
• Physical therapists
• Nutritionists

Why is a multidisciplinary approach beneficial for chronic headache management? Chronic headaches often have multiple contributing factors, including biological, psychological, and social elements. A team-based approach allows for comprehensive assessment and treatment, addressing all aspects of the condition and its impact on the patient’s life.

Living with Chronic Daily Headaches: Coping Strategies and Support

Dealing with chronic daily headaches can be challenging, but there are strategies to help cope with the condition and maintain quality of life:

Education and Self-Advocacy

How can educating yourself about your condition help? Understanding your specific type of headache, its triggers, and treatment options can empower you to take an active role in your care. Don’t hesitate to ask questions and seek clarification from your healthcare providers.

Support Groups

What benefits do support groups offer for individuals with chronic headaches? Connecting with others who experience similar challenges can provide emotional support, practical tips, and a sense of community. Many headache organizations offer both in-person and online support groups.

Workplace Accommodations

How can you manage chronic headaches in the workplace? Discuss your condition with your employer and explore potential accommodations, such as flexible work hours, adjusted lighting, or the ability to work remotely when symptoms are severe. Many employers are willing to make reasonable adjustments to support employees with chronic health conditions.

Mindfulness and Relaxation Techniques

Can mindfulness help manage chronic headaches? Practicing mindfulness and relaxation techniques can help reduce stress and tension, potentially decreasing headache frequency and intensity. These practices may include meditation, progressive muscle relaxation, or guided imagery.

Maintaining Social Connections

How can you maintain social relationships while dealing with chronic headaches? Open communication with friends and family about your condition can help them understand your limitations and provide support. Plan social activities during times when you typically feel better, and don’t hesitate to reschedule if necessary.

Living with chronic daily headaches requires patience, persistence, and a willingness to explore various management strategies. While the journey can be challenging, many individuals find effective ways to manage their symptoms and maintain a fulfilling life. Remember that seeking professional help and staying informed about your condition are crucial steps in this process.

Is It Normal To Get Headaches Everyday?

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May 16, 2022

No, it’s NOT normal to get headaches everyday

Most people have headaches from time to time. But if you have a headache more days than not, you might have chronic daily headaches, which come in many forms – most of them pretty disabling.

You may be suffering from chronic daily headaches if the headaches occur 15 days or more a month and you have experienced them for at least three months.

In general, there are four kinds of chronic daily headaches. They include:

• Chronic migraine headaches. These can affect one side or both sides of your head, have a throbbing sensation, and cause moderate-to-severe pain. They can also cause nausea, vomiting, or both. People tend to be sensitive to light and sound during these headaches.
• Chronic tension headaches. These tend to affect both sides of your head, cause mild-to-moderate pain, and produce a pain that feels like pressing or tightening but not throbbing.
• New daily persistent headaches. These occur suddenly, usually in people without a history of headaches. They often affect both sides of the head, cause pain that feels like pressing or tightening and produce mild-to-moderate pain.
• Hemicrania continua. These affect only one side of the head, are continuous with no pain-free periods, produce spikes of severe pain, respond to the prescription nonsteroidal anti-inflammatory drug Indocin, and are associated with one or more of the following:
  • Tearing or redness of the eye on the affected side of the head.
  • Nasal congestion or a runny nose.
  • Drooping eyelid or narrowing pupil.
  • The sensation of restlessness.

What Causes Chronic Headaches?

No one really knows why some people suffer from this debilitating condition. Conditions that may cause it include:

• Inflammation or other problems with the blood vessels in and around the brain.
• Strokes, in which blood vessels in the brain a blocked, reducing blood flow to the brain.
• Infections, including meningitis.
• High or low intracranial pressure.
• Brain tumors.
• Traumatic brain injury.
• Overuse of pain medication.

While the cause of these headaches is unclear, research suggests that you can do some things to help prevent them – or at least reduce their intensity:

• Avoid headache triggers. Keep track of things that appear to result in headaches, including foods you eat, activities you are doing, and the environment in which the headaches occur. If you can identify your headache triggers, you can try to avoid them.
• Do not overuse medication. Using headache medications more than twice a week can increase the frequency and severity of headaches. If you have been taking medication for a long time, consult a doctor about weaning yourself off. Some medicines cannot be stopped cold turkey.
• Get a good night’s sleep. Most adults need seven to eight hours of sleep a night. It’s best to go to bed and wake up at the same time every day. If you have trouble sleeping, see a doctor.
• Don’t skip meals. Eat healthy meals and avoid food or beverages that seem to trigger headaches. Lose weight if you’re obese.
• Get regular exercise. Physical activity can improve your physical and mental well-being and reduce stress. With your doctor’s OK, choose activities you enjoy, like walking or cycling.
• Reduce stress. Stress is a common trigger of chronic headaches. Try stress-reduction techniques, like yoga, tai chi, or meditation.
• Cut back on caffeine. Some headache medications include caffeine because they can help to reduce headache pain. But it can also aggravate headaches. Try reducing or eliminating caffeine.

When Should You See A Doctor?

Occasional headaches usually require no special medical attention. However, you should consult a doctor if you:

• Consistently have two or more headaches a week.
• Take pain reliever for your headaches on most days.
• Need more than the recommended dose of over-the-counter medicines to relieve headache pain.
• Experience changes in the pattern of your headaches, or they get worse.
• Find the headaches are disabling.

Seek immediate medical care if your headache:

• Is sudden and severe.
• Is accompanied by a fever, stiff neck, confusion, seizure, double vision, weakness, numbness, or difficulty speaking.
• Occurs after a head injury.
• Gets worse after you rest and take pain medication.

Get The Care You Need 

If your chronic headache is sudden and severe and associated with one of the symptoms above, you should call 911 and seek immediate medical attention. If you suffer from more common chronic headaches, visit your doctor for advice. If you do not have a doctor, Grady can help. If you need a primary care physician, call us at (404) 616-1000 or make an appointment online. We’ll arrange an appointment at a Primary Care Center near you. Doctors there can treat most conditions and provide access to Grady’s unparalleled medical specialty expertise.

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Are Your Daily Headaches a Sign of Something More Serious?

Don’t fret just yet. The pounding pain in your head may be annoying, but it doesn’t necessarily indicate a bigger problem.

There it is again — the throbbing in your dome. If you’re bothered by frequent headaches, you may be concerned that you have a more serious condition, such as a brain tumor or an aneurysm. And while those and other dangerous conditions can be marked by headaches, it’s likely that your pain is primary. In other words: It’s probably not the result of another condition.

Unfortunately, doctors don’t know what causes most headaches. According to some estimates, only 10% of headaches have a known cause. But there are contributing factors that can trigger chronic headaches, such as:

• Alcohol
• Caffeine
• Dehydration
• Hunger
• Lack of sleep
• Sensory triggers such as bright lights, loud noises and pungent smells
• Stress

Chronic headaches can also be linked to other disorders, including depression, anxiety, sinus infections, allergies and temporomandibular joint dysfunction, also known as TMJ. In order to figure out your headache pattern and identify your triggers, you may want to keep a headache diary to share with your doctor. The National Headache Foundation provides a handy template.

Here are a few common types of chronic headaches:

Tension headache

This is the most common type of headache and it’s likely that you’ve had more than one of these in your life. But for some people, they occur almost every day. Tension headaches affect both sides of your head with a pressing, moderate pain. Over-the-counter medications like ibuprofen (Advil) or acetaminophen (Tylenol) often help, but taking them for long periods of time can lead to headaches called “medication overuse” or “rebound” headaches. Instead, you may want to try meditation, relaxation techniques or heat therapy.

Migraine

Migraines, although less common, are more severe. The pain is intense, may pulsate and can be accompanied by nausea, sensitivity to light or sound, vomiting or visual disturbances called “auras.” Often, migraines only affect one side of the head, although they can affect both. They also affect women more often than men. Prescription medications are available to treat migraines, but you also may benefit from simply resting in a quiet, dark room and using hot or cold compresses. Progressive symptoms of more severe or frequent headaches, or any headache that is also associated with other neurological symptoms, should be evaluated by a physician

Cluster headache

Men are more likely to have these more sudden headaches, which are often marked by pain on one side of the head, behind the eye. They tend to happen in clustered periods of time, even multiple times a day, then disappear for a while. Eyes tend to water, and a restless feeling is common. These headaches usually require prescription medicines.

New daily persistent headache (NDPH)

If you suddenly get frequent headaches, you may have NDPH. The symptoms of NDPH can mimic tension headaches or migraines, but NDPH occurs in people who don’t have a history of headaches. Often, people with NDPH can remember exactly when the onset happened. Your doctor may need to run tests to make sure these headaches aren’t secondary — that is, a symptom of a serious underlying condition.

Although daily headaches might not be the result of a dangerous problem, they can affect your quality of life and shouldn’t be considered “normal.”

“Progressive symptoms of more severe or frequent headaches, or any headache that is also associated with other neurological symptoms, should be evaluated by a physician,” says Jonathan J. Russin, MD, a neurosurgeon at Keck Medicine of USC and assistant professor of clinical neurological surgery at the Keck School of Medicine of USC. “Even using these criteria, the majority of headaches will not represent an underlying problem. An exception is a ‘thunderclap’ headache, which refers to the sudden onset of the worst headache of your life. This type of headache should always be evaluated by a physician whether it is associated with other symptoms or not.”

Topics

cluster headache

Dr. Jonathan J. Russin

headaches

migraine

tension headache

Tina Donvito

Tina Donvito is a freelance writer covering health, culture, travel and parenting.

HEADACHE – Hadassah Medical Moscow

Traditional migraine therapy consists of behavioral therapy, relief of an already developed attack and preventive treatment aimed at preventing attacks. Behavioral therapy, a necessary step in effective patient management, is carried out during a conversation with the patient and includes: explaining the benign nature of migraine, dissuading the presence of an organic disease, discussing the role of attack triggers and the need to avoid them, risk factors for migraine chronicity (taking a large number of painkillers, stress , psycho-emotional states), as well as the rationale for treatment tactics (mechanisms of action of prescribed drugs).

Treatment of a migraine attack is prescribed depending on its intensity and the degree of maladaptation of the patient. With infrequent attacks of mild or moderate intensity, simple or combined analgesics are indicated; with severe nausea and vomiting – antiemetics. With a high intensity of pain and significant maladaptation, triptans are prescribed.

New drug groups have been approved worldwide for the treatment of migraine attacks. This, in turn, enables doctors to treat their patients more effectively, and for patients to reduce the number of days with a headache, improve quality of life, sleep, mood and performance.

Lasmiditan is a selective serotonin 1F receptor agonist that does not have vasoconstrictive activity. The role of lasmiditan in clinical practice has not yet been determined, but it is probably best suited for patients with relative contraindications to triptans due to cardiovascular risk factors.

In October 2019, the US Food and Drug Administration (FDA) approved lasmiditan oral tablets for the treatment of acute migraine in adults. The drug is currently not registered in the Russian Federation.

CGRP antagonists (Rimegepant and Ubrogepant) Monoclonal antibodies directed against the CGRP receptor or ligand. These are oral options available for the acute treatment of migraine in patients with insufficient response or contraindications (eg coronary artery disease) to triptan treatment.

Ubrogepant received US Food and Drug Administration (FDA) approval for the treatment of acute migraine in adults in December 2019year, and rimegepant received a similar FDA approval in February 2020. This group of drugs is not registered in the territory of the Russian Federation.

Preventive therapy is aimed at reducing the frequency, duration, intensity of attacks, the number of doses of painkillers and improving the quality of life of patients.

The main indications for course treatment: the frequency of days with GB > 4 per month, the lack of effectiveness of drugs for the relief of migraine attacks, the presence of risk factors for migraine chronicity (abuses, depression), prolonged aura (> 60 min). The duration of the course of treatment is from 3 to 12 months (an average of 4-6 months for episodic, 8-12 months for chronic migraine), then an attempt is made to gradually withdraw the drug (s) or reduce their dosage.

CGRP antagonists is a human monoclonal antibody that binds to and inhibits the calcitonin gene-related CGRP receptor (CGRP) and is a therapeutic target in migraine due to its putative role in mediating the transmission of trigeminovascular pain and the vasodilator component of neurogenic inflammation

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Large molecules in the form of monoclonal antibodies directed against the CGRP receptor or ligand are injected to prevent migraine. The US Food and Drug Administration (FDA) approved the CGRP antagonist monoclonal antibodies erenumab, fremanezumab, and galcanezumab in 2018 and eptinezumab in 2020 for the preventive treatment of migraine. In 2020, two drugs (erenumab, fremanezumab) were registered in the Russian Federation.

All about headaches – causes, diagnosis and treatment

It is extremely rare to meet people who have not experienced a headache at least once in their lives. A complaint of headache or cephalalgia is one of the most common complaints at a neurologist’s appointment. More than 13% of the population suffers from chronic headaches.

Types of headaches

Headache forms are various: migraine; tension headache; post-traumatic headache; headache caused by an increase or decrease in intracranial pressure; headache with prolonged use of drugs; headache caused by infections, etc.

• Vascular headache occurs due to spasm of arteries or vein dilation, insufficiency of their tone, slowing of blood flow.
• Muscle tension headache caused by muscle tension during prolonged non-physiological position (e.g. non-compliance with the principles of physiological seating by schoolchildren, drivers, programmers, etc.)
• Neuralgic headache is caused by nerve involvement.
• Psychic headache is associated with disturbances in the exchange of mediators of the central nervous system.
• Mixed headache is characterized by a combination of the above factors that develop sequentially or almost simultaneously.

It is necessary to mention extremely rare cephalalgias: cluster headache, chronic paroxysmal hemicrania, temporal arteritis, etc.

What is a headache?

Any headache should be a reason to contact a neurologist, so as not to miss the pathology of the nervous system or internal organs, signaling itself with a headache. This can be hypertension, diseases of the upper respiratory tract, kidneys, gastrointestinal tract, infectious, dental diseases, etc.

Headache diagnostics

The causes of the headache are established after undergoing a comprehensive neurological examination: Echo-encephalography, electroencephalography, ultrasound dopplerography of the vessels of the head and neck, rheoencephalography, P-graphy of the skull, magnetic resonance and computed tomography of the brain, examination of the fundus, consultations of the necessary specialists, laboratory research methods.

Treatment recommendations

Self-medication, prolonged uncontrolled use of painkillers to relieve headache symptoms should not be dealt with. In such a case, by drowning out the pain, the patient does not in any way affect its cause, which can be very serious. Moreover, the daily abuse of analgesics leads to the opposite effect – an overuse headache occurs. Daily uncontrolled intake of analgesics leads to drug disease, which is observed in 20% of the population of developed countries.

An integrated approach to treatment is needed, depending on the pathogenetic mechanisms of headache development identified during the examination. In each case, the treatment is selected individually and includes both relief of headache attacks and treatment in the period between attacks. The doctor’s arsenal includes medication methods, acupuncture, psychotherapy, autogenic training, post-isometric relaxation, manual therapy (especially for relieving muscle tension with tension headaches), biofeedback, massage, physiotherapy, physiotherapy, millimeter resonance therapy, laser therapy, homeopathic approaches .