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 reduce the frequency and intensity of chronic headaches.

Understanding Chronic Daily Headaches: More Than Just a Nuisance

Chronic daily headaches are a debilitating condition affecting millions of people worldwide. These persistent headaches occur 15 days or more per month for at least three months, significantly impacting quality of life. While occasional headaches are common, experiencing them on a near-daily basis is not normal and warrants attention.

The Four Primary Types of Chronic Daily Headaches

Chronic daily headaches manifest in various forms, each with distinct characteristics:

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

Chronic Migraine Headaches

Chronic migraines are characterized by throbbing pain, often affecting one or both sides of the head. They typically cause moderate to severe discomfort and may be accompanied by nausea, vomiting, and sensitivity to light and sound.

Chronic Tension Headaches

These headaches usually affect both sides of the head, causing mild to moderate pain. The sensation is often described as a pressing or tightening feeling rather than throbbing.

New Daily Persistent Headaches

This type of headache occurs suddenly, often in individuals with no prior history of chronic headaches. They typically affect both sides of the head and cause mild to moderate pain with a pressing or tightening sensation.

Hemicrania Continua

Hemicrania continua is a rare type of chronic daily headache that affects only one side of the head. It is characterized by continuous pain with occasional spikes of severe intensity. Unique symptoms may include tearing or redness of the eye on the affected side, nasal congestion, and a drooping eyelid.

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:

• Blood vessel inflammation or abnormalities in and around the brain
• Strokes resulting in reduced blood flow to the brain
• Infections such as meningitis
• Abnormal intracranial pressure (high or low)
• Brain tumors
• Traumatic brain injury
• Overuse of pain medication

Understanding these potential causes can help healthcare providers develop targeted treatment strategies for individuals suffering from chronic daily headaches.

Identifying and Managing Chronic Headache Triggers

While the underlying cause of chronic headaches may be unclear, identifying and managing triggers can help reduce their frequency and intensity. Common triggers include:

• Certain foods and beverages
• Environmental factors
• Stress
• Sleep disturbances
• Hormonal changes
• Physical exertion

Keeping a headache diary can be an effective way to track potential triggers. By recording details about your headaches, including when they occur, what you were doing, and what you ate or drank beforehand, you can identify patterns and make informed decisions about lifestyle changes.

Lifestyle Modifications to Prevent and Manage Chronic Headaches

While chronic daily headaches can be challenging to manage, several lifestyle modifications may help reduce their frequency and severity:

Maintain a Consistent Sleep Schedule

Aim for 7-8 hours of sleep per night and try to go to bed and wake up at the same time every day. Establishing a regular sleep routine can help regulate your body’s internal clock and reduce the likelihood of headaches triggered by sleep disturbances.

Practice Stress-Reduction Techniques

Stress is a common trigger for chronic headaches. Incorporating stress-reduction techniques such as yoga, meditation, or deep breathing exercises into your daily routine can help manage stress levels and potentially reduce headache frequency.

Stay Hydrated and Maintain a Balanced Diet

Dehydration and skipping meals can trigger headaches in some individuals. Ensure you’re drinking enough water throughout the day and eating regular, balanced meals to help maintain stable blood sugar levels.

Exercise Regularly

With your doctor’s approval, engage in regular physical activity. Exercise can improve overall well-being, reduce stress, and potentially decrease the frequency of chronic headaches. Choose activities you enjoy, such as walking, swimming, or cycling, to make exercise a sustainable part of your routine.

Limit Caffeine Intake

While caffeine can sometimes help alleviate headache pain, excessive consumption can lead to rebound headaches. Consider gradually reducing your caffeine intake to see if it impacts your headache frequency.

The Importance of Medication Management in Chronic Headache Care

Proper medication management is crucial for individuals with chronic daily headaches. Overuse of pain relievers, even over-the-counter options, can lead to medication overuse headaches, exacerbating the problem.

Guidelines for Medication Use

• Limit use of headache medications to no more than twice a week
• Consult with a healthcare provider before discontinuing any medications
• Consider preventive medications prescribed by a specialist for chronic headaches
• Be aware of potential side effects and interactions with other medications

If you find yourself relying on pain relievers more frequently, it’s essential to discuss this with your healthcare provider. They can help develop a more effective treatment plan that may include preventive medications or alternative therapies.

When to Seek Medical Attention for Chronic Headaches

While most headaches don’t require immediate medical attention, certain situations warrant prompt evaluation by a healthcare professional:

Consult a Doctor If You:

• Have two or more headaches per week consistently
• Rely on pain relievers for headaches most days
• Need more than the recommended dose of over-the-counter pain relievers
• Notice changes in your headache patterns or worsening pain
• Find your headaches to be disabling or significantly impacting your daily life

Seek Immediate Medical Care If Your Headache:

• Is sudden and severe (often described as a “thunderclap” headache)
• Is accompanied by fever, stiff neck, confusion, seizures, or neurological symptoms
• Occurs after a head injury
• Worsens despite rest and pain medication

These symptoms may indicate a more serious underlying condition that requires urgent medical attention.

Exploring 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

Several classes of medications can be used prophylactically to reduce the frequency and severity of chronic headaches:

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

These medications work by altering brain chemistry or blood flow to prevent the onset of headaches. It may take several weeks or months to determine the effectiveness of preventive medications, and dosages may need to be adjusted over time.

Botulinum Toxin Injections

For chronic migraine sufferers, Botulinum toxin (Botox) injections have shown promise in reducing headache frequency. The treatment involves injecting small amounts of Botox into specific points on the head and neck, typically every 12 weeks.

Nerve Blocks

Nerve block injections can provide temporary relief for some types of chronic headaches. These injections typically contain a local anesthetic and sometimes a corticosteroid to reduce inflammation and interrupt pain signals.

Neurostimulation Devices

Various neurostimulation devices have been developed to treat chronic headaches:

• Transcutaneous supraorbital nerve stimulation (t-SNS)
• Occipital nerve stimulation
• Vagus nerve stimulation
• Single-pulse transcranial magnetic stimulation (sTMS)

These devices work by delivering electrical or magnetic pulses to specific nerves or regions of the brain involved in headache pathways.

The Role of Complementary and Alternative Therapies in Chronic Headache Management

Many individuals with chronic daily headaches find relief through complementary and alternative therapies. While scientific evidence varies for these approaches, some people report significant benefits:

Acupuncture

This traditional Chinese medicine technique involves inserting thin needles into specific points on the body. Some studies suggest acupuncture may help reduce the frequency and intensity of chronic headaches.

Biofeedback

Biofeedback training teaches individuals to control certain bodily processes, such as muscle tension and heart rate, which may contribute to headaches. By learning to regulate these functions, some people can reduce headache frequency and severity.

Massage Therapy

Regular massage may help reduce muscle tension in the head, neck, and shoulders, potentially alleviating certain types of chronic headaches, particularly tension-type headaches.

Herbal Supplements

Some herbal supplements, such as feverfew and butterbur, have shown promise in preventing migraines. However, it’s crucial to consult with a healthcare provider before starting any herbal remedies, as they can interact with other medications and may have side effects.

Mindfulness and Meditation

Practicing mindfulness and meditation techniques can help reduce stress and tension, potentially decreasing the frequency of chronic headaches. These practices may also improve overall quality of life for those living with chronic pain conditions.

The Importance of a Multidisciplinary Approach to 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 or headache specialists
• Primary care physicians
• Pain management specialists
• Physical therapists
• Psychologists or psychiatrists
• Nutritionists
• Complementary medicine practitioners

By addressing chronic headaches from multiple angles, patients can develop a comprehensive treatment plan tailored to their specific needs and symptoms.

Living with Chronic Daily Headaches: Coping Strategies and Support

Chronic daily headaches can significantly impact an individual’s quality of life, affecting work, relationships, and daily activities. Developing effective coping strategies and seeking support are crucial for managing the emotional and psychological aspects of living with chronic pain:

Join a Support Group

Connecting with others who experience chronic headaches can provide emotional support, practical advice, and a sense of community. Many organizations offer in-person or online support groups for individuals with chronic pain conditions.

Practice Self-Care

Prioritizing self-care is essential when living with chronic pain. This may include setting boundaries, learning to say no to obligations when necessary, and engaging in activities that bring joy and relaxation.

Develop a Pain Management Plan

Work with your healthcare team to develop a comprehensive pain management plan that includes both pharmacological and non-pharmacological strategies. Having a plan in place can help you feel more in control when headaches occur.

Educate Friends and Family

Help your loved ones understand the impact of chronic headaches on your life. Educating them about your condition can foster empathy and support, making it easier to navigate social situations and maintain relationships.

Consider Cognitive Behavioral Therapy (CBT)

CBT can be an effective tool for managing the psychological impact of chronic pain. This type of therapy can help you develop coping strategies, change negative thought patterns, and improve overall quality of life.

The Future of Chronic Headache Research and Treatment

As our understanding of chronic daily headaches continues to evolve, researchers are exploring new avenues for treatment and prevention:

Genetic Studies

Ongoing genetic research aims to identify specific genes associated with chronic headache disorders. This could lead to more personalized treatment approaches based on an individual’s genetic profile.

Advanced Neuroimaging Techniques

Improved neuroimaging technologies are providing new insights into the structural and functional changes in the brain associated with chronic headaches. These advancements may lead to more targeted treatments in the future.

Novel Drug Therapies

Pharmaceutical companies continue to develop new medications targeting specific pathways involved in headache pathophysiology. For example, the recent introduction of CGRP antagonists has provided a new treatment option for many chronic migraine sufferers.

Neuromodulation Techniques

Research into non-invasive and minimally invasive neuromodulation techniques is ongoing, with the potential to provide new treatment options for those who don’t respond to traditional therapies.

As research progresses, individuals living with chronic daily headaches can look forward to more effective and personalized treatment options in the future. In the meantime, working closely with healthcare providers and staying informed about current management strategies can help improve quality of life and reduce the burden of 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 .