Daily Chronic Headaches
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
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.