Chronic Daily Headaches

Headaches are a common source of pain affecting 50% of the adult population at any given time. “Chronic daily headache” is an umbrella term for several types of headaches that are persistent, occurring daily over long periods of time. Often, chronic daily headaches interfere with your work, disturb your sleep, and decrease the quality of your life.

Primary Headaches

You have this disorder if you have experienced headaches for more than 15 days a month over the last three months.

A primary chronic daily headache is not linked to an underlying illness. It can start due to stress, a change in blood pressure, or a dilation or narrowing of your blood vessels. An example of this type of headache is a migraine, although there are multiple different subgroups of chronic daily headaches.

A primary chronic headache may be further divided into:

• Short-duration headaches that last under four hours.
• Long-duration headaches that last over four hours.

Secondary Headaches

Sometimes a headache is a red flag that something else is wrong. They are called secondary headaches because there is a second cause for the pain.

A secondary chronic daily headache results from an underlying illness, infection, a deformity in your vessels, or even from taking too much medication. The underlying problem needs to be treated in order for a headache to go away.

When to See a Doctor for Headaches

Occasional headaches are common and usually do not require medical attention. However, you may need to see a doctor if:

• You have more than 2 headaches each week
• You take an over-the-counter pain reliever for your headaches on most days
• Your over-the-counter pain medicine does not improve your headaches
• Headaches become more frequent or more intense
• The headaches interfere with your concentration or sleep

Diagnosis for Chronic Headaches

It is essential to first rule out infections, tumors, or other urgent issues that can lead to headaches. During diagnosis, a pain specialist will typically:

• Perform a neurologic exam.
• Review head/neck X-rays, CT scans, MRIs, and past medical records.
• Use diagnostic injections (blocks) to find the source of pain.

Depending on the cause, headaches may improve with medications, neck bracing, referrals to physical therapy, and chiropractic colleagues. The following treatments have shown promising results.

Treatment for Chronic Daily Headaches

Medications for chronic daily headaches serve two purposes: to control headaches once they start and to prevent headaches.

Medications That Control Headaches

• Acetaminophen (Tylenol) — an over-the-counter pain reliever.
• Nonsteroidal anti-inflammatory drugs (Aspirin, Motrin) — medications that stop pain resulting from inflammation.
• Triptans — a family of tryptamine-based drugs used to stop migraines and cluster headaches.

Medications That Prevent Headaches

There are multiple medications that reduce the frequency of chronic daily headaches. Consult an NSPC-affiliated pain specialist for a personalized regimen to prevent headaches.

• Amitriptyline (Elavil) is an antidepressant that reduces the duration of headaches as well as their severity. It is used for chronic tension-type headaches.
• Tizanidine (Zanaflex) is an alpha-adrenergic agonist that is effective for chronic migraine and chronic tension-type headaches. It reduces headache severity, frequency, and duration.
• Gabapentin (Neurontin), a gamma-aminobutyric acid analog, increases the number of headache-free days compared with a placebo in patients who have chronic daily headaches.
• Valproate (Depacon) and topiramate (Topamax) are anticonvulsants that can reduce the frequency of chronic migraines by 50%.
• Propranolol is a beta-blocker (a medication that is often used to control high heart rates) that also reduces the frequency of migraines. Its effectiveness for chronic migraine treatment is unclear.

Headaches Caused by Pain Medication Overuse

It is important to understand that the overuse of pain medications may actually lead to rebound headaches. Rebound headaches start as your body withdraws from the effects of medication that may have initially helped treat your headache.

Therefore, medication overuse may be a secondary cause of your headaches. In this situation, your doctor may stop the medications you are using for acute (sudden-onset) headaches and eventually replace them with prophylactic medications (medications that prevent headaches). This can determine if medication overuse is increasing your headaches.

Botox Injections for Migraines

For years, Botox injections have been used to relax spastic muscles in children with cerebral palsy and in patients with spasticity in their limbs after stroke or spinal cord injury. In a similar fashion, Botox relieves migraine pain by relaxing the muscles in the face and head.

As an added benefit, studies have shown Botox has a possible anti-inflammatory effect. It may even play a role in blocking pain signals from reaching the brain.

• How often can it be used and how long does it last? Administered at an affiliated NSPC office, Botox injections for migraine headaches can be repeated every 12 weeks if necessary. The effects, however, can last up to six months.
• Do the injections hurt? No, Botox injections do not typically cause any significant soreness. Some noted side effects include temporary flu-like symptoms, but this is relatively rare. There have been some reported issues regarding Botox spreading minimally from the area of injection, but the effects are temporary.
• Is Botox right for me? Proper evaluation and diagnosis are key and always the first step for patients within the NSPC

Headache Treatment from NSPC

Put a stop to daily chronic headaches and seek treatment from our network of pain specialists. Find a location near you and begin finding relief today!