Cognitive Health

What Are the Causes of Persistent Headaches?

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.

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

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
Skipping meals
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

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.

Medication

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

Disclaimer

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.

References:

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Garza I, Schwedt T. (2022). Chronic daily headache: Associated syndromes, evaluation and management. UpToDate.
Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018 Jan;38(1):1-211. doi: 10.1177/0333102417738202. PMID: 29368949.
Mack KJ. What incites new daily persistent headache in children? Pediatr Neurol. 2004 Aug;31(2):122-5. doi: 10.1016/j.pediatrneurol.2004.02.006. PMID: 15301832.
Westgate, C.S.J., Israelsen, I.M.E., Jensen, R.H. et al. Understanding the link between obesity and headache- with focus on migraine and idiopathic intracranial hypertension. J Headache Pain 22, 123 (2021). https://doi.org/10.1186/s10194-021-01337
Lanteri-Minet M, Ducros A, Francois C, Olewinska E, Nikodem M, Dupont-Benjamin L. Effectiveness of onabotulinumtoxinA (BOTOX®) for the preventive treatment of chronic migraine: A meta-analysis on 10 years of real-world data. Cephalalgia. 2022 Dec;42(14):1543-1564. doi: 10.1177/03331024221123058. Epub 2022 Sep 8. PMID: 36081276; PMCID: PMC9693763.
Chowdhury D, Tomar A, Deorari V, Duggal A, Krishnan A, Koul A. Greater occipital nerve blockade for the preventive treatment of chronic migraine: A randomized double-blind placebo-controlled study. Cephalalgia. 2023 Feb;43(2):3331024221143541. doi: 10.1177/03331024221143541. PMID: 36739512.
Da Silva, A.N. (2015), Acupuncture for Migraine Prevention. Headache: The Journal of Head and Face Pain, 55: 470-473. https://doi.org/10.1111/head.12525
Anker Stubberud, Emma Varkey, Douglas C. McCrory, Sindre Andre Pedersen, Mattias Linde; Biofeedback as Prophylaxis for Pediatric Migraine: A Meta-analysis. Pediatrics August 2016; 138 (2): e20160675. 10.1542/peds.2016-0675

This Article

Written by Leann Poston, M.D.

Published: Apr 12, 2023

Tags:

chronic daily headache, chronic headaches, headache

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