Chronic daily headache can represent a mixture of tension headaches and migraine headaches. Many patients have seen many different doctors, from primary care to specialists in an exhaustive attempt to eradicate their headaches. Those who suffer from chronic daily headaches know how it can severely impact their quality of life and those who are close to the person who suffers. Migraines are classified differently from general headaches in that they may have associated symptoms like nausea, vomiting and sensitivity to certain triggers like noise, different smells, allergies, stress and light. Chronic daily headaches, chronic migraine, chronic tension headaches and medication overuse headache have a frequency of 15 or more headaches per month for at least 3 months that last longer than 4 hours and possibly up to several days. In rare cases migraines may have an associated aura, an indication with flashing light or “tunnel vision” prior to an upcoming headache.
There are five different headaches that define chronic daily headache:
1. Chronic Tension-type Headaches
2. Chronic Migraine Headaches (transformed migraine)
3. New Daily Persistent Headaches
4. Hemicrania Continua Headaches
5. Analgesic Rebound Headaches or medication overuse headache
There are many different treatments available depending on the type of headache. There is no one item that is a ‘quick fix,” a multidisciplinary approach that includes both treatment of the existing headache and prevention of future headaches is optimal. It is important to have a thorough exam by a trained specialist to exclude any serious pathology. A thorough review of history that includes a record of prior treatments is also helpful.
There are many simple preventative measures that everyone suffering from chronic headache should incorporate into their lives as a form of self-help. If there is a known trigger, avoidance should be the first obvious plan of action. Regular exercise has been proven to help reduce headaches as well as stress reduction and is often helpful. A healthy well balanced diet with no processed foods will provide proper nourishment and allow your body to heal. A chronic stressful lifestyle can worsen headaches and may also result in depression; all these play off of each other and controlling stressful situations can minimize additional stress and associated pain. This is why yoga, massage, meditation and biofeedback relaxation techniques are also effective. There is also high quality of emerging evidence for a variety of supplements, herbs and vitamins that can be helpful. Ask your doctor if these treatments are right for you.
The first step is to reduce the risk of rebound headaches. If you are taking pain medication (opioid or over the counter analgesic medications like anti-inflammatory medications) more than three days a week, you are at risk for developing rebound headaches and will continue to worsen as the medication dosage increases. Helpful medications for preventive treatment include serotonin medications (SSRI), beta blockers, Anti-epileptic medications, tricyclic antidepressants (TCA’s) like Nortriptyline, Botox (Botulinum toxin) and sparingly anti-inflammatory medications (NSAIDs). Neurologists will often prescribe “abortive” headache medications or give intravenous medications.