Daily Chronic Headache

Daily chronic headaches represent a group of primary and secondary headache disorders that remain poorly understood and are often inappropriately managed. They are generally considered to consist of headaches that occur 15 or more days per month, for four or more hours per day, for at least six months. It affects an estimated four to five percent of the general population.

There is a female preponderance of 2:1 to 4:1. The prevalence of daily chronic headaches is not thought to change appreciably with age, and it’s typically seen in people in their 30s.

Causes of Daily Chronic Headaches

Potential causes leading to daily chronic headaches can include stress, depression, excessive caffeine consumption, alcohol abuse, lack of sleep, taking a new herbal supplement, a change in hormone regimen (e.g., a new birth control pill), or major life stress.

Treatment Options for Daily Chronic Headaches

Treatment for any underlying diseases or conditions often stops frequent headaches. When no underlying diseases or conditions are present, treatment focuses on preventing the pain before it starts.

Specific prevention strategies vary, depending on which type of headache you have and whether medication overuse is contributing to these headaches. If you’re taking pain relievers more than two days per week, the first step in treatment may be to stop using these drugs. When you’re ready to begin preventive therapy, your doctor may recommend:

• Antidepressants. Tricyclic antidepressants such as nortriptyline (Pamelor) — can be used to treat chronic headaches. These medications can also help treat the depression, anxiety and sleep disturbances that often accompany chronic daily headaches. Other antidepressants, such as the selective serotonin reuptake inhibitor (SSRI) fluoxetine (Prozac, Sarafem), may also be helpful for treatment of depression and anxiety.
• Beta blockers. These drugs, commonly used to treat high blood pressure, are also a mainstay for preventing episodic migraines. Some beta blockers include atenolol (Tenormin), metoprolol (Lopressor, Toprol-XL) and propranolol (Inderal, Innopran XL). Sometimes beta blockers are prescribed in combination with antidepressants, and this combination is sometimes more effective than either medication on its own.
• Anti-seizure medications. Some anti-seizure drugs seem to prevent migraines. These medications may be used to prevent chronic daily headaches as well. Options may include gabapentin (Neurontin) and topiramate (Topamax).
• NSAIDs. Nonsteroidal anti-inflammatory drugs — such as naproxen (Anaprox, Naprelan) — may be helpful, especially if you’re going through withdrawal from other pain relievers. They may also be used periodically when the headache is more severe.
• Others. Injections of a local anesthetic around a nerve or injections of a numbing agent and corticosteroid at the point of pain (trigger point injections) are sometimes recommended for chronic daily headaches. Although their role needs to be better defined, botulinum toxin type A (Botox) injections provide relief for some people as well.