Overview

Most people have headaches from time to time. But if you have a headache more days than not, you may be experiencing chronic daily headaches.

The incessant nature of chronic daily headaches makes them among the most disabling headaches. Aggressive initial treatment and steady, long-term management may reduce pain and lead to fewer headaches.

Symptoms

By definition, chronic daily headaches occur 15 days or more a month, for at least 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 last more than four hours. They include:

  • Chronic migraine
  • Chronic tension-type headache
  • New daily persistent headache
  • Hemicrania continua

Chronic migraine

This type typically occurs in people with a history of episodic migraines. On eight or more days a month for at least three months, migraines tend to have the following features:

  • Affect one side or both sides of your head
  • Have a pulsating, throbbing sensation
  • Cause moderate to severe pain
  • Are aggravated by routine physical activity

And they cause at least one of the following:

  • Nausea, vomiting or both
  • Sensitivity to light and sound

Chronic tension-type headache

These headaches tend to have the following features:

  • Affects both sides of your head
  • Cause mild to moderate pain
  • Cause pain that feels pressing or tightening, but not pulsating
  • Aren't aggravated by routine physical activity

Some people may have skull tenderness.

New daily persistent headache

These headaches come on suddenly, usually in people without a headache history. They become constant within three days of your first headache. They have at least two of the following characteristics:

  • Usually affects both sides of your head
  • Cause pain that feels like pressing or tightening, but not pulsating
  • Cause mild to moderate pain
  • Aren't aggravated by routine physical activity

Hemicrania continua

These headaches:

  • Affect only one side of your 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)
  • May sometimes become severe with development of migraine-like symptoms

In addition, hemicrania continua headaches are associated with at least one of the following:

  • Tearing or redness of the eye on the affected side
  • Nasal congestion or runny nose
  • Drooping eyelid or pupil narrowing
  • Sensation of restlessness

When to see a doctor

Occasional headaches are common, and usually require no medical attention. However, consult your doctor if:

  • You usually have two or more headaches a week
  • You take a pain reliever for your headaches most days
  • You need more than the recommended dose of over-the-counter pain remedies to relieve your headaches
  • Your headache pattern changes or your headaches worsen
  • Your headaches are disabling

Seek prompt medical care if your headache:

  • Is sudden and severe
  • Accompanies a fever, stiff neck, confusion, seizure, double vision, weakness, numbness or difficulty speaking
  • Follows a head injury
  • Gets worse despite rest and pain medication

Causes

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 may cause non-primary chronic daily headaches include:

  • 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

Medication overuse headache

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 analgesics — more than two days a week (or nine days a month), you're at risk of developing rebound headaches.

Risk factors

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

Complications

If you have chronic daily headaches, you're also more likely to have depression, anxiety, sleep disturbances, and other psychological and physical problems.

Prevention

Taking care of yourself might help ease chronic daily headaches.

  • Avoid headache triggers. Keeping a headache diary can help you determine what triggers your headaches so that you can avoid the triggers. Include details about every headache, such as when it started, what you were doing at the time and how long it lasted.
  • Avoid medication overuse. Taking headache medications, including over-the-counter medications, more than twice a week can increase the severity and frequency of your headaches. Consult your doctor about how to wean yourself off the medication because there can be serious side effects if done improperly.
  • Get enough sleep. The average adult needs seven to eight hours of sleep a night. It's best to go to bed and wake up at regular times, as well.
  • 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. Lose weight if you're obese.
  • Exercise regularly. Regular aerobic physical activity can improve your physical and mental well-being and reduce stress. With your doctor's OK, choose activities you enjoy — such as walking, swimming or cycling. To avoid injury, start slowly.
  • Reduce stress. Stress is a common trigger of chronic headaches. Get organized. Simplify your schedule. Plan ahead. Stay positive. Try stress-reduction techniques, such as yoga, tai chi or meditation.
  • Reduce caffeine. While some headache medications include caffeine because it can be beneficial in reducing headache pain, it can also aggravate headaches. Try to minimize or eliminate caffeine from your diet.
March 10, 2015
References
  1. Garza I, et al. Overview of chronic daily headache. http://www.uptodate.com/home. Accessed Jan. 6, 2015.
  2. Yancey JR, et al. Chronic daily headache: Diagnosis and management. American Family Physician. 2014;89:642.
  3. Halker RB, et al. Chronic daily headache: An evidence-based and systematic approach to a challenging problem. Neurology. 2011;76:S37.
  4. Headache: Hope through research. National Institute of Neurological Disorders and Stroke. www.ninds.nih.gov/disorders/headache/detail_headache.htm. Accessed Jan. 5, 2015.
  5. Ahmed F, et al. Chronic daily headaches. Annals of Indian Academy of Neurology. 2012;15:S40.
  6. Headaches and complementary health approaches. National Center for Complementary and Alternative Medicine. http://nccam.nih.gov/health/pain/headachefacts.htm. Accessed Jan. 5, 2015.