Daily Chronic Headaches: Everything You Need to Know

Headaches are one of the main reasons for consultation in clinical practice. They can be disabling.

Last update: September 14, 2022

Chronic daily headaches are a set of disorders characterized by the recurrence of headaches, for at least 15 days a month, for 3 months or more per year, more than 4 hours per day. About 3-5% of the world’s population have headaches every day or nearly every day.

So migraines are the main reason for consulting for a neurological symptom in clinical practice.

The presence of daily chronic pain can incapacitate a person, because it affects their quality of life and mental health. As well as causing physical, social and work functioning impairments. It is estimated that about 90% of patients with chronic daily headaches have coexisting psychiatric problems.

What are daily chronic headaches?

As we already anticipated, they are those headaches that appear 15 days or more per month, for more than 3 months in a year. In this way, the concept applies to any type of headache that occurs almost daily or daily.

It includes a wide variety of subtypes:

  • Hemicrania continua.
  • Cluster headache.
  • transformed migraine.
  • Chronic tension headache.
  • Idiopathic intracranial hypertension.

Transformed migraine and chronic tension headache are the most frequent. Due to their recurring nature, they are disabling. The intensity interferes with work and sleep.

The associated risk factors are the following:

  • Female sex.
  • Obesity.
  • Caffeine abuse.
Migraine is known to several women. Its recurrence affects daily activities.

primary and secondary

The aforementioned are the primary (or true) daily chronic headaches. They are not caused by another condition and are not related to functional or structural changes. They are subdivided into short-term and long-term.

Secondaries are caused by another condition. They are triggered by some physiological alteration and include those caused by the abuse of analgesics (including over-the-counter ones).



Causes of Chronic Daily Headaches

The cause of primary chronic daily headaches is not well understood, as there is no single source. However, in the secondary ones, conditions such as the following can be found:

  • Inflammation of blood vessels (or vasculitis) in and around the central nervous system: stroke, hypertensive urgency, and the presence of a cerebral aneurysm are included.
  • Nerve inflammation (or neuralgia): in particular, the occipital nerve or the trigeminal nerve.
  • infections: meningitis, sinusitis.
  • Changes in intracranial pressure: decrease or increase.
  • Presence of a space occupying lesion.
  • After a traumatic brain injury.
  • Rest disorders: obstructive sleep apnea.

The use of pain relievers, including over-the-counter pain relievers, when taken for more than 2 days per week or 9 days per month, increases the risk of rebound headaches.



Treatment of chronic daily headaches

Treatment of chronic daily headaches depends on whether they are of primary or secondary cause. In the first, the doctor focuses on preventing the onset of pain. In the case of the latter, the approach points to the origin.

Several drugs are used to prevent its appearance:

  • Tricyclic antidepressants (such as nortriptyline) or selective serotonin reuptake inhibitors (such as fluoxetine), which also help with depression, anxiety, and associated sleep disorders.
  • Beta-blockers, such as atenolol, metoprolol, and propranolol.
  • Anticonvulsants, such as topiramate and divalproex sodium.
  • Non-steroidal anti-inflammatory drugs (NSAIDs).
  • Botulinum toxin injection (especially useful in those who do not tolerate daily oral medication).
Antidepressants can help improve associated mental health symptoms.

When should you go to the doctor?

You should see a doctor if chronic daily headaches have the following characteristics:

  • They are incapacitating.
  • Get worse or change pattern.
  • Require a higher dose of over-the-counter pain relievers than is recommended.
  • Are accompanied by other symptoms, such as fever, neck stiffness, disorientation, seizures, slurred speech, double vision, or loss of muscle strength.

Chronic daily headaches require prompt medical attention. However, to decrease intensity or frequency until professional evaluation, triggers should be avoided.

Do not self-medicate or take over-the-counter pain relievers for more than 2 days a week. As an alternative to acetaminophen or ibuprofen, naproxen may be recommended.

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