Most people have headaches from time to time. But if you have a headache more days than not, you might have chronic daily headaches.
Rather than a specific headache type, chronic daily headaches include a variety of headache subtypes. Chronic refers to how often the headaches occur and how long the condition lasts.
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.
By definition, chronic daily headaches occur 15 days or more a month, for longer than three months. True (primary) chronic daily headaches aren't caused by another condition.
There are short-lasting and long-lasting chronic daily headaches. Long-lasting headaches last more than four hours. They include:
This type typically occurs in people with a history of episodic migraines. Chronic migraines tend to:
And they cause at least one of the following:
These headaches tend to:
These headaches come on suddenly, usually in people without a headache history. They become constant within three days of your first headache. They:
In addition, hemicrania continua headaches are associated with at least one of the following:
Occasional headaches are common, and usually require no medical attention. However, consult your doctor if:
Seek prompt medical care if your headache:
The causes of many chronic daily headaches aren't well-understood. True (primary) chronic daily headaches don't have an identifiable underlying cause.
Conditions that might cause nonprimary chronic daily headaches include:
This type of headache usually develops in people who have an episodic headache disorder, usually migraine or tension type, and take too much pain medication. If you're taking pain medications — even over-the-counter — more than two days a week (or nine days a month), you're at risk of developing rebound headaches.
Factors associated with developing frequent headaches include:
If you have chronic daily headaches, you're also more likely to have depression, anxiety, sleep disturbances, and other psychological and physical problems.
Taking care of yourself might help ease chronic daily headaches.
Your doctor will likely examine you for signs of illness, infection or neurological problems and ask about your headache history.
If the cause of your headaches remains uncertain, your doctor might order imaging tests, such as a CT scan or MRI, to look for an underlying medical condition.
Treatment for an underlying condition often stops frequent headaches. If no such condition is found, treatment focuses on preventing pain.
Prevention strategies vary, depending on the type of headache you have and whether medication overuse is contributing to your headaches. If you're taking pain relievers more than three days a week, the first step might be to wean yourself off these drugs with your doctor's guidance.
When you're ready to begin preventive therapy, your doctor may recommend:
Antidepressants. Tricyclic antidepressants — such as nortriptyline (Pamelor) — can be used to treat chronic headaches. These medications can also help treat the depression, anxiety and sleep disturbances that often accompany chronic daily headaches.
Other antidepressants, such as the selective serotonin reuptake inhibitor (SSRI) fluoxetine (Prozac, Sarafem, others), might help in treating depression and anxiety, but have not been shown to be more effective than placebo for headaches.
The use of one drug is preferred, but if one drug doesn't work well enough, your doctor might consider combining drugs.
For many people, complementary or alternative therapies offer relief from headache pain. It's important to be cautious, however. Not all complementary or alternative therapies have been studied as headache treatments, and others need further research.
Herbs, vitamins and minerals. Some evidence exists that the herbs feverfew and butterbur help prevent migraines or reduce their severity. A high dose of vitamin B-2 (riboflavin) also might reduce migraines.
Coenzyme Q10 supplements might be helpful in some individuals. And oral magnesium sulfate supplements might reduce the frequency of headaches in some people, although studies don't all agree.
Ask your doctor if these treatments are right for you. Don't use riboflavin, feverfew or butterbur if you're pregnant.
Before trying complementary or alternative therapy, discuss the risks and benefits with your doctor.
Chronic daily headaches can interfere with your job, your relationships and your quality of life. Here are suggestions to help you cope with the challenges.
You're likely to start by seeing your family doctor or a general practitioner. However, you may be referred to a headache specialist.
Here's some information to help you get ready for your appointment.
Be aware of pre-appointment restrictions. When you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet.
Take a family member or friend along, if possible, to help you remember information.
For chronic headaches, some questions to ask your doctor include:
Don't hesitate to ask other questions.
Your doctor is likely to ask you questions, such as:
To ease your headache pain until you see your doctor, you might: