How to Manage a Headache That Won’t Go Away

It can be incredibly frustrating to deal with a stubborn headache, whether it won’t go away or it just keeps coming back. 

Persistent headaches can negatively impact your work, social life, and enjoyment of day-to-day activities. 

In this article, we’ll explain some common causes of long-lasting headaches and when to seek urgent medical attention, and we’ll also explore whether your headache might be a symptom of COVID-19. 

When should I be worried?

Long-lasting headaches are common, with about 15% of adults in the United States experiencing migraines or severe headaches each year.

However, you should seek immediate medical attention if you’re experiencing a particularly intense headache or if your headache involves: 

• loss of vision

• loss of consciousness

• uncontrollable vomiting

• pain lasting longer than 72 hours, with a pain-free period shorter than 4 hours

• any symptom that is frightening and abnormal for you

If you have a concerning headache alongside an autoimmune, liver, kidney, or heart condition, contact your healthcare provider for advice.  

Causes and treatments

Headaches that spring from different causes require different treatments. 

COVID-19 headaches

Users of the ZOE Health Study app reported headache as one of the most common symptoms of COVID-19. 

The ZOE COVID Study involved over 63,000 individuals who tested positive for COVID-19 between June 2021 and January 2022. During this time, the participants consistently reported their infection status and symptoms, including headache. 

The study showed that about 78% of people with COVID-19 reported headaches when Delta was dominant and 75% when Omicron was dominant. 

COVID-19 headaches tend to: 

• be moderate to severe in pain

• last longer than 3 days

• feel like a pulsing, pressing, or stabbing pain

• be unresponsive to painkillers 

• feel painful on both sides of the head 

A multi-center study reported that almost 20% of individuals who experienced headaches during their SARS-CoV-2 infection were still experiencing them at 3 months. After 9 months, 16% of the participants were still experiencing them. 

The scientists also found a link between how severe the headache pain was when people first had COVID-19 and how long they lasted after the infection.

However, this study had a few very important limitations, and further studies are needed to evaluate the possibility of chronic COVID-19-related headaches.

Migraine

Migraine is a complex neurological condition that typically includes intense and recurring headaches. 

The International Headache Society categorize migraines into three primary subtypes: those with an aura, those without an aura, and chronic migraines. 

Aura refers to a period of sensory disturbances usually happening before the headache pain. Chronic migraine is a condition involving frequent headaches that happen on 15 or more days, over 3 or more months, and that includes other symptoms of migraine on 8 or more days per month.

Other symptoms can accompany the intense headache pain, such as:

• sensitivity to light, sound, or smells

• nausea and vomiting

• sensitivity to movement 

Females are three to four times more likely to experience migraines than males. In the U.S., migraines are most common at ages 18–44.

Some ways to manage migraine pain include:

• taking over-the-counter medications

• avoiding intense sensory stimuli

• practicing stress reduction techniques

• trying aromatherapy

In the long-term, certain lifestyle changes may help reduce the frequency or intensity of migraines.

Rebound headaches 

While painkillers can be a valuable headache treatment, overuse of over-the-counter pain relief medications can cause rebound headaches. Rebound headaches are common in people who regularly experience migraines and tension headaches. 

Rebound headaches are common worldwide, affecting 1–2% of people globally. 

They happen on more than 14 days a month and are typically worse in the morning. People with rebound headaches often report having additional neck pain.

While they tend to be alleviated by taking over-the-counter medication, rebound headaches usually return as soon as the pain relief wears off, creating a vicious cycle.

If you experience rebound headaches, speak to your healthcare provider about ways to manage them. Your doctor may suggest gradually reducing the amount of medication that you’re using. 

It may also be helpful to make some lifestyle changes to alleviate some of the underlying causes of the primary headache. We’ll discuss these further down.

Tension-type headaches

Tension-type headaches (TTHs) are headaches that experts believe are associated with tightness in the head muscles. 

A TTH can last anywhere from 30 minutes to 7 days. 

The pain is typically:

• mild to moderate in intensity

• a tightening or pressing sensation

• on both sides of the head

In contrast to migraines, TTHs do not involve:

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About 3% of people worldwide experience TTHs every year. TTHs are most common at ages 40–49, while females are slightly more likely to experience them across all ages.

The first line of treatment for TTH is over-the-counter medicines, like aspirin. However, if this doesn’t work, your healthcare provider may suggest other medications.

In the long term, certain medications and biofeedback may help reduce the frequency or intensity of TTHs. While lifestyle changes can improve headaches that occur during a migraine, there is little evidence for their effectiveness in TTHs.

Cervicogenic headaches

A cervicogenic headache is a headache arising from pain in the upper spine.

The experience feels like a stabbing pain shooting up from one side of your neck. 

The pain may be more severe when you pivot your head sharply to one side. This typically causes a reduced range of movement in the neck. 

Neck injuries, such as whiplash, are often the cause of cervicogenic headaches, but arthritis in the upper spine can also cause them.

The first line of treatment is usually physical therapy. However, manipulative therapy, specific exercise regimens, steroid injections, and — in rare cases — surgery are effective in some cases. 

Hemicrania continua

Hemicrania continua (HC) is a headache condition characterized by a dull, one-sided pain lasting longer than 3 months. Throughout this constant headache, HCs involve recurring episodes of increased pain ranging from moderate to very severe in intensity.

Alongside the headache, symptoms include restlessness or agitation, as well as sensitivity to movement. 

Some symptoms occur only on the same side as the headache pain, such as:

• a bloodshot or teary eye

• nasal congestion or runny nose

• a swollen or drooping eyelid

• facial sweating

• a constricted pupil

Scientists conservatively estimate that 1% of headache cases are HCs. 

The average age of someone with HC is 30, with cases most prevalent in young adults in their 20s to 30s. HC is also twice as common in females than in males.

If you suspect your headache is HC, speak with your healthcare provider to decide the next steps. Indomethacin, a non-steroidal anti-inflammatory drug, is used as the first line of treatment for HC. 

If indomethacin is not an option, your healthcare provider may explore alternative medications or other treatments, like botox injections.

Dehydration

While it may seem like simple advice, it can be easy to forget to drink enough water. Being dehydrated can be enough to cause a headache and can make an existing headache condition worse. 

If this is the problem, there’s a solid solution — drink more water!

Some tips to help boost your daily water intake include:

• starting your day with a large glass of water 

• drinking water with each meal

• keeping a water bottle accessible

• using a straw to make it easier to drink 

• flavoring your water with herbs, fruits, or vegetables

General treatment and long-term prevention

Long-lasting headaches can be frustrating, but making small changes to your lifestyle may help.  

You might like to try: 

• reducing stress levels through meditation and mindfulness

• enjoying gentle forms of exercise and regular movement

• staying well-hydrated, especially in the heat

• looking at your diet and changing what you eat

• limiting potentially triggering ingredients like caffeine and alcohol

• ensuring you allow 7–8-hour periods for restful sleep

• using massage therapy to reduce tension in your neck and shoulders

Summary

Experiencing a headache that won’t go away can be concerning. 

While most headaches respond well to treatment and are rarely serious, you should seek urgent medical attention if you’re experiencing frightening or abnormal symptoms.

Migraines, rebound headaches, tension-type headaches, cervicogenic headaches, and hemicrania continua are all headache conditions with different presentations and treatments.

Over-the-counter medications can often be helpful for headache pain. However, depending on the severity of your symptoms, you may need to speak with a healthcare provider. 

They can work with you to decide the best treatment option for managing your headache.

Sources

Cervicogenic headache. StatPearls. (2022). https://www.ncbi.nlm.nih.gov/books/NBK507862/

Dehydration and headache. Current Pain and Headache Reports. (2021). https://pubmed.ncbi.nlm.nih.gov/34268642/

Food as trigger and aggravating factor of migraine. Neurological Sciences. (2012). https://pubmed.ncbi.nlm.nih.gov/22644176/

Giving researchers a headache – sex and gender differences in migraine. Frontiers in Neurology. (2020). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7642465/

Headache? When to seek medical attention. (2010). https://headaches.org/headache-when-to-seek-medical-attention/

Hemicrania continua. StatPearls. (2022). https://www.ncbi.nlm.nih.gov/books/NBK557568/

Lifestyle modifications for migraine management. Frontiers in Neurology. (2022). https://pubmed.ncbi.nlm.nih.gov/35370920/

Medication-overuse headache. Practical Neurology. (2019). https://pubmed.ncbi.nlm.nih.gov/31273078/ 

Medication-overuse headache. StatPearls. (2022). https://www.ncbi.nlm.nih.gov/books/NBK538150/

Migraine headache. StatPearls. (2022). https://pubmed.ncbi.nlm.nih.gov/32809622/

Post-COVID-19 persistent headache: a multicentric 9-months follow-up study of 905 patients. Cephalalgia. (2022). https://pubmed.ncbi.nlm.nih.gov/35166156/ 

SEEDS for success: lifestyle management in migraine. Cleveland Clinic Journal of Medicine. (2019). https://pubmed.ncbi.nlm.nih.gov/31710587/

Symptom prevalence, duration, and risk of hospital admission in individuals infected with SARS-CoV-2 during periods of omnicron and delta variant dominance: a prospective observational study from the ZOE COVID Study. The Lancet. (2022). https://www.thelancet. com/journals/lancet/article/PIIS0140-6736(22)00327-0/fulltext 

Tension-type headache. BMJ. (2008). https://pubmed.ncbi.nlm.nih.gov/18187725/

The presence of headache at onset in SARS-CoV-2 infection is associated with long-term post-COVID headache and fatigue: a case-control study. Cephalalgia. (2021). https://pubmed.ncbi.nlm.nih.gov/34134526/ 

The prevalence and impact of migraine and severe headache in the United States: updated age, sex, and socioeconomic-specific estimates from government health surveys. Headache. (2021). https://pubmed.ncbi.nlm.nih.gov/33349955/ 

Treatment of medication overuse headache – a review. Acta Neurologica Scandinavica. (2019). https://pubmed.ncbi.nlm.nih.gov/30710346/

When the pain won’t go away: Managing chronic headaches

The occasional headache can be a pain and nuisance. The good news is they typically come and go with little or no treatment. But for many, headaches can be a source of continual and sometimes debilitating pain that can last for days, weeks or longer.

Chronic headaches occur 15 days or more per month over a 3-month period. They can happen at any age and can be severe enough to interfere with daily activities.  It’s no wonder that the frequent pain and other symptoms that come with chronic headaches can often lead to depression, anxiety, sleep problems and other physical and mental health issues.

What are the types of chronic headaches?

There are multiple types of headaches that can be become long-lasting. The most common types of chronic headaches include:

• Tension headaches. Normal tension headaches are common among teens and adults and come and go over time. But when headache days outnumber headache-free days, they become chronic. Tension headaches can affect both sides of the head and are marked by dull pain, tightness or pressure around the forehead, back of head or neck. Tension headaches can last 30 minutes to several hours.
• Migraines. Migraine attacks are less common, but more severe than tension headaches. Intense throbbing pain may occur on one or both sides of the head. Accompanying symptoms may include nausea or vomiting; sensitivity to light, sound or smells; or visual disturbances called auras. In the U.S, nearly 40 million Americans suffer from migraines, including 28 million women and girls, according to the World Health Organization. Migraines can last 4 to 72 hours.
• Cluster headaches. These sudden headaches are typically marked by pain on one side of the head behind the eye. They can last for weeks or several months and sometimes occur multiple times a day. Cluster episodes are usually followed by a period of remission that can last several months or years. Men are more likely than women to have cluster headaches, which can also cause restlessness and watery eyes. Medication is often prescribed as treatment.
• New daily persistent headaches. While these sudden headaches can mimic migraines or chronic tension-type headaches, new daily persistent headaches occur in people who do not have a history of headaches. Testing may be required to determine if the onset of frequent headaches is caused by an underlying condition.
• Hemicrania continua. This rare but treatable headache disorder causes continuous pain on one side of the face and head for at least three months. Additional symptoms include red and eyes, drooping eyelid, sweating, runny nose and nasal congestion. Some sufferers of this disorder also experience restlessness and migraine-like symptoms, such as light sensitivity and stabbing pain.

What causes chronic headaches?

The cause of chronic headaches can be a head-scratcher. It’s estimated that only 10 percent of headaches have a known underlying cause.

There are, however, certain risk factors that may trigger persistent headaches, including:

• Fluctuating hormonal changes, especially when estrogen falls around the time a woman has her period
• Genetics
• High levels of stress
• Lack of sleep/sleep disturbance
• Anxiety and depression
• Too much caffeine and alcohol
• Skipped meals
• Weather changes
• Certain foods

Another cause of chronic headaches is overuse of pain medication. While prescription and over-the-counter pain medication can relieve discomfort, long-term use can make things worse for headache sufferers. Medication overuse headaches, or rebound headaches, can occur when pain medication is taken for more than three days a week, according to the National Institute of Neurological Disorders and Stroke.

Is a persistent headache a symptom of long COVID?

Headaches are one of the most common symptoms among COVID-19 “long-haulers,” or those with lingering issues related to the virus. New persistent daily headaches are being seen more and more in people who contract COVID-19. Individuals who already deal with regular migraines and other headache disorders also report increased frequency of headaches after a COVID diagnosis, even when they have a relatively minor case of the virus.

What’s the best defense against a lingering COVID-19 headache? Get vaccinated. Medical experts agree that it’s the best way to avoid the coronavirus and the chance of serious illness, hospitalization and long-haul symptoms, including headaches.

How can I prevent chronic headaches?

Chronic daily headaches can stop you in your tracks, but there are some healthy steps you can take to ease their frequency:

• Identify (and avoid) triggers. Keep a headache diary to help determine what causes your headaches so that you can avoid the triggers. Track the onset of each headache, what you were doing at the time and how long it lasted. 
• Ease up on the pain meds. Talk with an Indigo primary care provider about how much pain medication you’re taking and how to wean yourself if medication is worsening your symptoms.
• Make sleep a priority.The average adult needs seven to nine hours of sleep a night. A consistent sleep schedule is the ticket to a better night’s sleep, so try to go to bed and wake up at the same time every day. Talk to your doctor if you have sleep disturbances, such as snoring.
• Switch up your diet. Establish regular mealtimes or eating patterns and stick to them. Opt for more anti-inflammatory foods like fatty fish, whole grains and dark, leafy greens. Eliminate potential triggers, such as highly processed foods, chocolate, aged cheeses, processed meats high in nitrates, high-sugar foods and gluten.
• Exercise regularly.It’s not just great for your body. Regular physical activity can improve your mental well-being, reduce stress and ease muscle tension that can trigger headaches. Aim for 30 minutes of moderate exercise at least five days a week. Start slowly to avoid injury.
• Tamp down the stress.Life is stressful, especially when you’re balancing work, kids and…well, everything else. Try stress-reduction techniques, such as meditation, deep breathing, yoga or tai chi. Even a simple “me” time-out, like a walk and getting some fresh air, can make a difference.
• Cut back on the caffeine.It’s true that some headache medications include caffeine, and a small about can help reduce headache pain. But too much of the stuff can raise blood pressure and trigger a headache. Soda pop and energy drinks are the worst offenders.
• Limit alcohol. To reduce headaches and other alcohol-related health issues, the Centers for Disease Control and Prevention (CDC) recommends limiting your intake to one drink a day for women or two drinks a day for men.

When should I see a doctor about my headaches?

While occasional head pain is normal, you should talk with a medical provider if:

• Your headaches occur more than twice a week.
• You take pain relievers daily or most days for headache pain.
• Your headaches affect your quality of life and ability to perform daily activities.
• Headaches happen more often or worsen over time.

How can Indigo help my chronic headaches?

If you have chronic headaches, you don’t need to live with the pain. And you don’t need to wait for relief. Refreshingly friendly, convenient Indigo Online Care is as close as your phone or favorite device.

With our quick and easy online scheduling and check-in, you can chat directly with one of our Indigo primary care providers when and where it works best for you. Video visits are available 8 am to 8 pm, every day.

During your appointment, a provider will evaluate your symptoms to understand what type of headaches you are having and what may be triggering them. Together, you’ll create a treatment plan focused on pain management and prevention that’s most effective for you. They will also prescribe medication, if needed, and schedule a follow-up appointment to see how you’re doing.

And if you need a higher level of care to get to the root of your chronic headaches, an Indigo provider will coordinate a referral to a headache specialist.

When is a headache an emergency?

Sometimes a headache could be a symptom of something more serious. If you have any of the following symptoms, it’s a good idea to head to your nearest ER for immediate care:

• A severe headache that comes on suddenly
• Neurological symptoms, such as confusion, numbness, or difficulty with coordination, walking or speaking
• Vision loss or unconsciousness
• High fever, stiff neck, nausea or vomiting
• A headache that follows a head injury
• Headache pain that lasts more than 72 hours with less than 4 hours without pain

Headache from painkillers (abuses)

Everyone knows that headaches are relieved by painkillers. They were created to heal her, right? But in fact, overuse of painkillers itself can cause headaches.

When does pain from painkillers appear?

There is a separate type of headache that doctors and scientists call “drug-induced (or abuse) headache.” This diagnosis is made when a person takes conventional painkillers for a migraine or tension-type headache 15 or more days per month during the last three months . And if we are talking about combined painkillers (they contain several active ingredients, these are drugs such as spasmalgon or citramone) or triptans, then it is enough to take them only 10 days a month for three months to get an abuse headache.

Video

See all

What is migraine and how to deal with it. Lecture by a neurologist-cephalologist.

Migraine. Problems of diagnosis and treatment. Lecture for neurologist Yulia Azimova

Why do we have a headache? How to treat a migraine? Neurologist Kirill Skorobogatykh

How does it feel?

Abusive headache usually occurs daily. The nature of this pain is very different. Can be moderate, but debilitating. May be intense. It can be like a migraine, maybe like a regular headache. At the same time, migraine attacks do not go anywhere and appear with the usual frequency.

How is overuse headache treated?

To save a person from an overuse headache, most often doctors recommend completely giving up painkillers. However, often against the background of the withdrawal of painkillers, the condition worsens (a kind of “breaking” occurs). In order to ease this period, we carry out special supportive detoxification procedures (droppers) or select painkillers from other groups for replacement. Along with detoxification, we prescribe prophylactic treatment, which helps to reduce the number of days with a headache and reduce the amount of painkillers.

Read more articles about headaches in our Telegram channel.

Literature:

• Brief recommendations of experts on the diagnosis and treatment of migraine:
• Drug-induced headache (in English):
  https://www.migrainetrust.org/about-migraine/types-of-migraine/other-headache-disorders/medication-overuse-headache/
• Treatment of drug-induced headache (in English):
  https://www. nice.org.uk/guidance/cg150/ifp/chapter/treatment-for-medication-overuse-headache

Why does my head hurt | How to get rid of a headache

Headaches are the most common pain of our time. Most often, people suffer and complain about pain in the head. The appearance of pain is associated with various causes: metabolic disorders, vascular diseases, colds and viral infections. However, there is a headache that occurs due to problems in the spine or muscles and requires manual treatment.
Manual therapist Vechkutov Boris Vasilyevich spoke about the main and most common types of headaches.

Tension headache

It manifests itself due to lack of sleep, mental overload, long-term viewing of films or being on the Internet.
Pain: there is no clear localization in the head area, the pain is of moderate intensity, often with a feeling of fullness from the inside, and is not unilateral.
Treatment: no cycling observed. Pain is easily relieved with simple analgesics, good sleep and rest, as well as manual therapy sessions and massage, which is recommended to improve blood flow to the head and reduce pain.

Cervicogenic headache

It occurs due to problems in the cervical spine and can be one of the syndromes of the vertebral artery, which is often also called cervical migraine. It often manifests itself due to prolonged static overloads. For example, when the head is tilted forward for a long time: in the process of cooking, reading, or using a phone or tablet.
Pain: Pain of moderate intensity, combined with a feeling of heaviness in the occipital region and a squeezing helmet or hoop on the head. It happens one-sided, but more often with the migration of pain from right to left. Characterized by reduced visual acuity, sometimes tinnitus, and always accompanied by pain or stiffness in the cervical spine
Treatment: is treated with mild analgesics, but long-term remission is possible only through treatment of the cervical spine. For this, sessions of manual therapy, massage, exercise therapy are recommended. To unload the cervical spine and correct the correct position of the head and cervical spine, use a rigid Shants splint.

Migraine

Often there is no specific reason for the occurrence.
Pain: the intensity of the pain is very severe with increasing, always only one-sided and does not migrate from right to left. At peak pain, nausea occurs, sometimes vomiting, increased pain from bright light and sharp sounds.
Treatment: Pain can only be relieved with medication. In the case of migraine, massage and manual therapy are practically useless, and normal sleep often does not alleviate the condition either.

Chronic paroxysmal hemicrania

The exact causes of the manifestation of pain have not been established, but sharp turns of the head, alcohol consumption are considered factors that can cause hemicrania.
Pain: the nature of the pain is above average, occurs simultaneously and manifests itself unilaterally.