What should I do about chronic headaches that last for months?

Doctor's Answers 1

What are chronic headaches?

The constant nature of chronic daily headaches makes them one of the most disabling headache conditions. Aggressive initial treatment and steady, long-term management might reduce pain and lead to fewer headaches. Chronic daily headaches occur 15 days or more a month, for longer than three months. There are short-lasting and long-lasting chronic daily headaches. Long-lasting headaches last more than four hours. They include:

• Chronic migraine

• Chronic tension-type headache

• New daily persistent headache

• Hemicrania continua

Chronic migraines tend to affect one side or both sides of the head, have a pulsating, throbbing sensation, and cause moderate to severe pain. Most sufferers of chronic migraines experience nausea, vomiting, and/or are sensitive to light and sound.

Chronic tension-type headaches tend to affect both sides of the head, cause mild to moderate pain that feels pressing or tightening, but not pulsating.

Individuals with new daily persistent headache report that these headaches come on suddenly, usually in people without a headache history. They become constant within three days of their first headache and might have features of chronic migraine or chronic tension-type headache

In hemicrania continua, the headaches affect only one side of the head, are daily and continuous with no pain-free periods, cause moderate pain with spikes of severe pain, respond to the prescription pain reliever indomethacin (Indocin), and can become severe with development of migraine-like symptoms

Causes of chronic headaches

Some possible causes of headaches include:

• Tightening of the muscles of the head and neck, which can create tension and pain

• Stimulation of the trigeminal nerve, which is the primary nerve that’s found in your face. Activation of this nerve can cause pain behind the eyes in addition to stuffy nose and eye redness that’s associated with some types of headache.

• Changes in the levels of certain hormones, such as serotonin and estrogen. When the levels of these hormones fluctuate, a headache can occur.

• Genetics

Often, headaches are triggered by lifestyle or environmental factors such as stress, changes in weather, caffeine use, or lack of sleep.

Overuse of pain medication can also cause a constant headache. This is called a medication overuse headache or a rebound headache. One is at risk for these types of headache if he takes OTC or prescription pain medication more than two days a week or nine days a month.

Other possible causes of chronic headaches include the following:

• Inflammation or other problems with the blood vessels in and around the brain, including stroke

• Infections, such as meningitis

• Intracranial pressure that's either too high or too low

• Brain tumor

• Traumatic brain injury

Factors associated with developing frequent headaches include:

• Female sex

• Anxiety

• Depression

• Sleep disturbances

• Obesity

• Snoring

• Overuse of caffeine

• Overuse of headache medication

• Other chronic pain conditions

Individuals with chronic daily headaches are more likely to have depression, anxiety, sleep disturbances, and other psychological and physical problems.

Treating chronic headaches

The following strategies and interventions may be useful:

• Identify the headache triggers and learn to avoid them if possible. Keeping a headache diary can help one determine what triggers his headaches so that he can avoid the triggers. When documenting the headaches, it is pertinent to include details about every headache, such as when it started, what he is doing at the time and how long it lasted.

• Consider the possibility of medication overuse. Taking headache medications, including over-the-counter medications, more than twice a week can increase the severity and frequency of our headaches. Discuss with a doctor to see how these medications can be weaned off in a gradual fashion. If one is taking pain relievers more than three days a week, the first step might be to wean oneself off these drugs with a doctor's guidance.

Get enough sleep. The average adult needs seven to eight hours of sleep a night. Sleep deprivation can aggravate headaches and make very day a challenge to the individual who has decreased energy and poor concentration.

Don't skip meals. Eat healthy meals at about the same times daily. Avoid food or drinks, such as those containing caffeine, that seem to trigger headaches.

Exercise regularly. Regular aerobic physical activity can improve our physical and mental well-being and reduce stress.

Manage stress effectively. Stress is a common trigger of chronic headaches. It may be useful to write down all the tasks that one needs to attend to and learn to prioritise them, and then tackle one task at a time. Multitasking can be stressful for many individuals. Putting aside them in the daytime to do planning and mental processing is also useful as one is less likely to ruminate over work related issues at night and in bed.

Reduce caffeine. While some headache medications include caffeine because it can be beneficial in reducing headache pain, it can also aggravate headaches.

Medications that can be used to prevent or treat constant headaches include:

Antidepressants called tricyclics, such as amitriptyline and nortriptyline, which can help prevent headaches. Other antidepressants, such as the selective serotonin reuptake inhibitor (SSRI) fluoxetine, might help in treating depression and anxiety, but have not been shown to be more effective than placebo for headaches.

Beta-blockers. These drugs, commonly used to treat high blood pressure, are also a mainstay for preventing episodic migraines. These include atenolol, metoprolol and propranolol.

Anti-seizure medications. Some anti-seizure drugs seem to prevent migraines and might be used to prevent chronic daily headaches, as well. Options include topiramate, divalproex sodium and gabapentin.

NSAIDs. Prescription nonsteroidal anti-inflammatory drugs — such as naproxen sodium and ibuprofen — might be helpful, especially if you're withdrawing from other pain relievers. They can also be used periodically when the headache is more severe. These medications should be used sparingly, as they can lead to medication overuse or rebound headaches.

Botulinum toxin. OnabotulinumtoxinA (Botox) injections provide relief for some people and might be a viable option for people who do not tolerate daily medication well. Botox would most likely be considered if the headaches have features of chronic migraines. It is an injection of a neurotoxin derived from the bacteria that causes botulism.

Cognitive behavioural therapy is also useful in the treatment of chronic headaches. This can be given either alone or in a group.

Similar Questions

How are sinus headaches differentiated from other headaches?

Headaches can be pretty painful and can really affect your husband’s quality of life! Before we assume though that sinus problems are causing his headaches, we would usually take a detailed history to find out the location and pattern of the headaches as well as other associated symptoms like blocked or runny nose, colour of his nasal discharge, any nausea or vomiting, vision problems. For example, headaches which are more likely to be due to sinus problems may occur over the forehead, between the eyes, over the cheeks.

Photo of Dr Annabelle Leong

Answered By

Dr Annabelle Leong

ENT Doctor

Why do I get recurring headaches that affect my sleep, and how can I tell this apart from a tension headache or migraine?

You should see a specialist if the headache persists. An MRI if the brain may be necessary.

Photo of Dr Ivan  Ng

Answered By

Dr Ivan Ng

Neurosurgeon

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