What Are the Causes of Persistent Headaches? 

December 18, 2023
A woman with a headache.

Headaches keep more people from working and enjoying life than almost any other medical condition. According to data from the Global Burden of Disease study, each day, 15.8% of the world’s population has a headache, making it the second leading cause of years lived with disability.1 Headaches are disabling, and they cause missed time from school and work.

Nearly everyone has experienced an occasional short-term headache. These headaches generally resolve on their own with rest or an over-the-counter pain reliever. Chronic headaches are persistent or recurrent headaches that occur 15 or more days per month for at least three months. Examples include migraine, cluster, and tension headaches.

Types of Chronic Headaches 

There are five types of chronic daily headaches that typically last more than four hours each day. The signs and symptoms vary, but these headaches classically recur and persist. Daily headaches of shorter duration can also occur, such as chronic cluster headaches, chronic paroxysmal hemicrania, hypnic headaches, and primary stabbing headaches.2

Chronic Migraines

Migraines are severe headaches characterized by throbbing or pulsating pain, typically on one side of the head. Episodic migraines can transition to chronic migraines, a condition with daily or near-daily mild-to-moderate intensity headaches. The diagnostic criteria include the presence of headaches at least 15 days of the month, with migraine headache symptoms on at least eight days.3

Common migraine symptoms include:

  • Sensitivity to light or sound
  • Nausea
  • Vomiting
  • Fatigue
  • Visual disturbances (aura)

Medication withdrawal headaches can complicate chronic migraines. These headaches result from taking high doses of pain relief medications for a long period and then abruptly stopping.

Chronic Tension-type headaches

Chronic tension headaches are bilateral headaches that are typically described as a band around the head, not a throbbing headache. Chronic tension-type headaches have a more gradual onset and are rated as mild to moderate in intensity. Most people with tension headaches do not have other symptoms.

A woman with a headache.

Hemicrania continua

Hemicrania is characterized by continuous pain that varies in severity on one side of the head and face. Pain is cyclic and commonly occurs three to five times per day. Hemicrania continua is considered chronic when headache pain continues for at least three months without shifting sides or having pain-free periods.

Other symptoms:

  • Nasal congestion or runny nose
  • Redness or tearing in the eye on the affected side
  • Drooping eyelid
  • Constricted pupil
  • Light sensitivity
  • Sweating
  • Nausea

New daily persistent headache

Daily persistent headache syndrome is a headache that begins rather abruptly and is daily and non-stop from the onset. Surgery, stressful life events, and respiratory infections are common triggers.4

Medication overuse headache (MOH)

Medication overuse headaches typically occur as a result of treating another headache. Taking pain relievers regularly, especially in higher doses, can cause rebound headaches when the medication is stopped.

What Can Cause Daily Headaches? 

Chronic stress, medical conditions, surgeries, and infections can increase your risk for chronic headaches. Some chronic headaches, such as migraines, also have a genetic component. Medication side effects and lifestyle choices can also increase your risk of chronic headaches.


Lifestyle choices can increase your risk of chronic headaches. Some of these choices include the following:

  • Smoking
  • Lack of sleep
  • Chronic stress
  • Poor diet
  • Lack of physical activity
  • Loud noises
  • Odors
  • Glare
  • Skipping meals or hunger
  • Alcohol use

Pre-existing Conditions 

Chronic medical conditions, such as obesity and diabetes, can increase the risk of chronic headaches, especially migraines. Migraines have a genetic component, and there is some evidence of a link between obesity and an increased risk of migraine headaches.5 Maintaining a healthy body composition by consuming a healthy diet and increasing physical activity can also help reduce headaches.

Uncorrected vision and dental issues can also increase the risk of headaches.

Medication Side Effects

Several medications, including pain relievers, can increase your risk of headaches.

Some common medications with headaches as a known side effect include the following:

  • Minoxidil
  • Sleeping pills
  • Pain relievers
  • Medications that contain caffeine
  • Triptans
  • Nitrates
  • Hormone therapy
  • Weight loss medications
A man with a headache.

Treatment Options for Chronic Headaches 

Treatment options for chronic headaches will depend on the type of headache being treated. Here are some common lifestyle, medication, and non-invasive therapies that are used to treat chronic headaches.

Lifestyle Treatment

If you are prone to chronic daily headaches, lifestyle modifications may help prevent or reduce the frequency of your headaches. Consider trying some or all of the following:

  • Sleep: sleep deprivation increases the likelihood of headaches. Try to get 7 to 9 hours of restful sleep each night.
  • Diet: watch for common dietary migraine triggers such as chocolate, soy, nitrate-containing foods, monosodium glutamate, and food colorings.
  • Odors: Avoid strong perfumes and other odors that may trigger headaches.
  • Manage stress: Engage in enjoyable and stress-relieving activities. Spend time with your partner; sex is good for your health.
  • Caffeine: Caffeine can trigger headaches and relieve symptoms once headaches occur. Keep track of the relationship between caffeine use and headaches to determine when or even if you should use caffeine.
  • Bright lights: Bright lights can trigger a headache or make symptoms worse. Like caffeine, light can cause migraines but can also be used therapeutically to reduce symptoms.
  • Smoking: chemicals in cigarette smoke, nicotine, and increased risk for pulmonary infections can increase the risk for headaches.


Medications used to treat chronic daily headaches depend on the type of headache.

Some of the commonly used medications to treat persistent migraines include the following:

  • Propranolol
  • Amitriptyline
  • Topiramate
  • Valproic acid

Common medications used to treat other types of chronic headaches:

  • Tylenol
  • Non-steroidal anti-inflammatories
  • Acetaminophen and caffeine
  • Indomethacin

Non-invasive Procedures 

Non-invasive procedures can help relieve some types of chronic headaches.

  • Botulinum toxin: The PREEMPT 1 and 2 clinical trials evaluated the use of botulinum toxin in treating chronic migraines and found that injections decreased the number of headaches per month.6
  • Occipital nerve block: Injecting a local anesthetic into the occipital nerve reduces chronic migraine frequency.7
  • Acupuncture: Research shows that acupuncture can effectively reduce headache frequency and intensity.8
  • Biofeedback: Biofeedback techniques can help reduce stress and reduce the frequency and intensity of migraine and tension headaches.9
Author: Leann Poston, M.D.
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