Dealing with chronic headaches

Headaches are never fun. They make your day miserable until they fade or some over-the-counter medicine helps resolve the pain. But for some, the headaches are every day. The pain can range from mild to severe and sometimes, they never go away. These are called chronic daily headaches.

A chronic daily headache is any headache that occurs 15 or more days out of the month and is present for three months or longer.  People of any age are susceptible to chronic daily headaches. Risk factors include obesity, sleep apnea, anxiety, depression, fibromyalgia and chronic back pain.

If you develop regular headaches and suspect this could be the onset of a chronic daily headache, reach out to your primary healthcare provider. It also can be helpful to track your headaches or keep a journal so you have a good idea of how often they occur.

This information can also be useful when you see your healthcare provider because it can be difficult to remember every headache you have over several days or weeks. And the notes you take about your headaches – where they occur and other associated symptoms – can also help determine what types of chronic daily headaches you’re dealing with.

TYPES OF CHRONIC DAILY HEADACHES

• Chronic migraines – Chronic migraines are similar to episodic migraines, which are a genetic disorder that involves the dysregulation of neurotransmitters, inflammation and excitable electrical activity in the brain.

While migraines are generally an episodic disorder – meaning you’ll have a migraine headache followed by periods where you have no pain – it’s possible for them to transition to chronic migraines. Another potential cause for the transition are lifestyle factors. For instance, the overuse of either prescription or over-the-counter (OTC) headache medications can lead to what’s known as a medication overuse headache.

• Chronic tension-type headache – Like chronic migraines, chronic tension-type headaches often begin as episodic headaches but transition to chronic headache. What separates this type of headache from migraines are the symptoms.

Tension-type headaches are typically mild to moderate in terms of pain and don’t interfere with a person’s daily life the same way the severe pain associated with migraines can. Additionally, tension-type headaches feel more like squeezing or pressing than throbbing and affect both sides of the head or the whole head. Some migraine symptoms such as sensitivity to light and noise as well as nausea and vomiting are not present with these tension-type headaches.

• Chronic post-traumatic headache – A chronic post-traumatic headache is a recurring headache that develops after some sort of head trauma. Traditionally, post-traumatic headaches are present after the injury but resolve within a few weeks to a few months, but some patients develop the prolonged course where it becomes a more chronic pattern.

• New daily persistent headache – This type of headache is a continuous headache that begins without any real warning. It can affect both sides of the head and share symptoms with both migraine and tension-type headaches. But unlike those chronic types of headaches, these generally come out of the blue with no previous headache history.

• Hemicrania continua – While the other types of chronic daily headaches are more typical, hemicrania continua is a fairly rare headache disorder. One of the characteristics of this particular type of headache is that it involves only one side of the head and the pain is continuous and daily from the onset.

Hemicrania continua is also different from the other types of headaches in that it’s associated with autonomic symptoms. These can include tearing or redness of the eye on the same side as the pain as well as unequal pupils or a drooping eyelid on the same side as the pain. It can also include nasal congestion or a runny nose on the same side as the pain. As for what causes these rare headaches, the exact cause isn’t known.

TREATMENT OPTIONS
When we think about headache treatment, we tend to think about a reactive approach. You develop a headache, you take the over-the-counter medication of your choice (aspirin, Tylenol, etc.) and you go on about your day. With these chronic-type headaches, though,  it’s all about getting ahead of the headaches in the first place with preventive treatment.

Preventive treatment is typically medication you take every day, regardless of whether or not you have a headache that day. The goal is reducing the overall number of headaches you have. If you’re taking OTC medications more than two days a week to manage headache pain, you need to talk to your healthcare provider about switching to this prevention medicine.

For these two kinds of chronic headaches, some of the more effective migraine treatments include medications typically used for seizures, blood pressure and depression. There’s also been some overlap in using those to treat tension-type headaches. Tension-type headaches may respond better to some of the seizure or antidepressant medications as well as muscle relaxers.

Based on symptoms, treatment for post-traumatic and new daily headaches generally follows the treatment of migraines or tension-type headaches. For hemicrania continua, patients typically respond to an anti-inflammatory medicine called indomethacin.

Nearly everyone has had headache pain, and most of us have had it many times. A minor headache is little more than a nuisance that’s relieved by an over-the-counter pain reliever, some food or coffee or a short rest. But if your headache is severe or unusual, you might worry about stroke, a tumor, or a blood clot. Fortunately, such problems are rare.