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

Understanding Chronic Daily Headaches: More Than Just a Nuisance

Chronic daily headaches are a debilitating condition that affects millions of people worldwide. Unlike occasional headaches, these persistent pain episodes occur 15 days or more per month for at least three months. This frequency and duration can significantly impact an individual’s quality of life, making it crucial to understand the nature of these headaches and seek appropriate treatment.

The Four Main Types of Chronic Daily Headaches

Chronic daily headaches can manifest in various forms, each with distinct characteristics. Here are the four primary types:

1. Chronic migraine headaches: These can affect one or both sides of the head, causing moderate-to-severe throbbing pain. They often come with nausea, vomiting, and sensitivity to light and sound.
2. Chronic tension headaches: Typically affecting both sides of the head, these headaches produce mild-to-moderate pain that feels like pressing or tightening, but not throbbing.
3. New daily persistent headaches: These occur suddenly, usually in people without a history of headaches. They often affect both sides of the head and cause mild-to-moderate pressing or tightening pain.
4. Hemicrania continua: This type affects only one side of the head continuously, with no pain-free periods. It produces spikes of severe pain and responds to the prescription nonsteroidal anti-inflammatory drug Indocin.

Unraveling the Mystery: Potential Causes of Chronic Headaches

The exact cause of chronic daily headaches remains elusive, but several factors may contribute to their development:

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

Identifying and Managing Chronic Headache Triggers

While the underlying causes of chronic headaches may be complex, identifying and managing triggers can help reduce their frequency and intensity. Some common triggers include:

• Certain foods and beverages
• Environmental factors (e.g., bright lights, loud noises)
• Stress and emotional distress
• Lack of sleep or irregular sleep patterns
• Hormonal changes
• Dehydration
• Skipping meals

To identify your personal triggers, consider keeping a headache diary. Record details about your headaches, including when they occur, what you were doing before they started, and any potential triggers you noticed. This information can help you and your healthcare provider develop an effective management plan.

Lifestyle Modifications to Prevent and Manage Chronic Headaches

While chronic daily headaches can be challenging to manage, certain lifestyle modifications may help prevent or reduce their occurrence:

1. Maintain a Consistent Sleep Schedule

How can sleep impact chronic headaches? Irregular sleep patterns or insufficient sleep can trigger headaches in many individuals. Aim for 7-8 hours of quality sleep each night and try to maintain a consistent sleep schedule, even on weekends.

2. Regular Exercise

What role does physical activity play in headache management? Regular exercise can improve overall health, reduce stress, and potentially decrease the frequency of chronic headaches. Consult with your doctor to develop an appropriate exercise routine that works for you.

3. Stress Management Techniques

How can you effectively manage stress to reduce headaches? Incorporate stress-reduction techniques such as meditation, deep breathing exercises, yoga, or tai chi into your daily routine. These practices can help alleviate tension and potentially reduce the frequency of stress-induced headaches.

4. Dietary Considerations

What dietary changes can help manage chronic headaches? Maintain a balanced diet and avoid skipping meals. Some people find relief by eliminating potential trigger foods such as aged cheeses, processed meats, and foods containing MSG. Additionally, staying hydrated by drinking plenty of water throughout the day can help prevent dehydration-induced headaches.

5. Limit Caffeine Intake

How does caffeine affect chronic headaches? While caffeine can sometimes help relieve headache pain, excessive consumption or sudden withdrawal can trigger headaches in some individuals. If you regularly consume caffeinated beverages, consider gradually reducing your intake to see if it impacts your headache frequency.

The Importance of Proper Medication Management

Overuse of pain medication is a common pitfall for those suffering from chronic headaches. Paradoxically, using headache medications more than twice a week can lead to medication overuse headaches, increasing the frequency and severity of pain.

What steps should you take to avoid medication overuse? If you find yourself relying on pain relievers frequently, consult with your healthcare provider. They can help you develop a plan to safely reduce medication use and explore alternative treatment options.

When to Seek Medical Attention for Chronic Headaches

While occasional headaches are common, certain situations warrant medical attention. You should consult a doctor if:

• You consistently have two or more headaches per week
• You’re taking pain relievers for headaches on most days
• You need more than the recommended dose of over-the-counter medicines to relieve headache pain
• You experience changes in the pattern of your headaches or they worsen
• Your headaches are disabling

When should you seek immediate medical care for a headache? If you experience any of the following symptoms, seek emergency medical attention:

• A sudden, severe headache
• Headache accompanied by fever, stiff neck, confusion, seizure, double vision, weakness, numbness, or difficulty speaking
• Headache occurring after a head injury
• Headache that worsens after rest and pain medication

Exploring Treatment Options for Chronic Daily Headaches

Managing chronic daily headaches often requires a multifaceted approach. What treatment options are available for chronic headache sufferers? Here are some potential strategies:

1. Preventive Medications

Certain medications can help reduce the frequency and severity of chronic headaches when taken regularly. These may include:

• Antidepressants
• Beta-blockers
• Anti-seizure medications
• Calcitonin gene-related peptide (CGRP) monoclonal antibodies

2. Acute Pain Relief Medications

For immediate pain relief, your doctor may recommend:

• Over-the-counter pain relievers (used judiciously to avoid medication overuse headaches)
• Triptans
• Ergotamines
• Gepants

3. Non-Pharmacological Treatments

What non-medication options can help manage chronic headaches? Consider exploring these alternatives:

• Biofeedback
• Cognitive-behavioral therapy
• Acupuncture
• Massage therapy
• Mindfulness meditation

4. Nerve Blocks and Injections

In some cases, nerve blocks or Botox injections may be recommended to provide relief from chronic headaches.

5. Neuromodulation Devices

FDA-approved devices that stimulate specific nerves may help some individuals manage their chronic headaches.

The Role of a Multidisciplinary Approach in Chronic Headache Management

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

• Neurologists
• Pain management specialists
• Physical therapists
• Psychologists or psychiatrists
• Nutritionists

How can a multidisciplinary team benefit chronic headache sufferers? By addressing various aspects of the condition simultaneously, this approach can provide comprehensive care tailored to each individual’s unique needs and circumstances.

The Impact of Chronic Daily Headaches on Quality of Life

Chronic daily headaches can significantly impact an individual’s quality of life, affecting various aspects such as:

• Work productivity and attendance
• Social relationships and activities
• Mental health and emotional well-being
• Sleep quality
• Overall physical health

How can individuals cope with the emotional toll of chronic headaches? Joining support groups, practicing self-care, and seeking professional mental health support when needed can all play crucial roles in managing the emotional aspects of living with chronic pain.

Emerging Research and Future Directions in Chronic Headache Treatment

The field of headache medicine continues to evolve, with ongoing research into new treatment modalities and a deeper understanding of the underlying mechanisms of chronic headaches. Some promising areas of research include:

• Advanced neuroimaging techniques to better understand headache pathophysiology
• Gene therapy approaches for headache prevention
• Novel drug targets for more effective and tailored treatments
• Personalized medicine approaches based on genetic and biomarker profiles
• Advanced neuromodulation techniques

What potential breakthroughs might we see in chronic headache treatment in the coming years? While it’s difficult to predict specific outcomes, ongoing research offers hope for more effective and personalized treatment options in the future.

Empowering Patients: Self-Advocacy and Education in Chronic Headache Management

Living with chronic daily headaches can be challenging, but empowering yourself with knowledge and self-advocacy skills can make a significant difference in your journey towards better management. Here are some strategies to consider:

1. Educate Yourself

Stay informed about the latest research and treatment options for chronic headaches. Reliable sources include:

• National headache foundations and organizations
• Peer-reviewed medical journals
• Reputable health websites

2. Maintain Open Communication with Your Healthcare Team

How can you effectively communicate with your healthcare providers? Be prepared for your appointments by:

• Keeping a detailed headache diary
• Listing your questions and concerns
• Bringing a list of current medications and treatments
• Being honest about your symptoms and how they affect your daily life

3. Explore Clinical Trials

Participating in clinical trials can provide access to cutting-edge treatments and contribute to the advancement of headache research. Discuss with your doctor whether any ongoing trials might be suitable for you.

4. Connect with Others

Joining support groups or online communities for chronic headache sufferers can provide emotional support, practical tips, and a sense of community. How can connecting with others benefit your headache management journey? Sharing experiences and coping strategies with those who understand your struggles can be invaluable in maintaining a positive outlook and feeling less isolated.

The Importance of a Holistic Approach to Chronic Headache Management

While medical treatments play a crucial role in managing chronic daily headaches, adopting a holistic approach that addresses all aspects of your health and well-being can lead to better outcomes. Consider incorporating the following elements into your headache management plan:

1. Mind-Body Practices

How can mind-body practices contribute to headache management? Techniques such as mindfulness meditation, progressive muscle relaxation, and guided imagery can help reduce stress and tension, potentially decreasing headache frequency and intensity.

2. Natural Remedies

Some individuals find relief from chronic headaches through natural remedies. While scientific evidence varies, some options to discuss with your healthcare provider include:

• Herbal supplements (e.g., feverfew, butterbur)
• Essential oils for aromatherapy
• Magnesium supplementation
• Acupressure

3. Environmental Modifications

How can you create a headache-friendly environment? Consider making adjustments to your home and workspace, such as:

• Using anti-glare screens and adjusting lighting to reduce eye strain
• Implementing noise-reduction strategies
• Maintaining good air quality and ventilation
• Creating a calm and clutter-free space

4. Ergonomic Considerations

Poor posture and ergonomics can contribute to tension headaches. What ergonomic improvements can help reduce headache risk? Consider:

• Using an ergonomic chair and desk setup
• Taking regular breaks to stretch and move
• Maintaining proper posture while using electronic devices

By adopting a comprehensive approach that combines medical treatments, lifestyle modifications, and holistic practices, individuals living with chronic daily headaches can work towards better pain management and improved quality of life. Remember that finding the right combination of strategies may take time and patience, but with perseverance and support from your healthcare team, it is possible to achieve better control over your chronic headaches.

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 .