Constant headaches: What they could mean and how to manage

Do you experience headaches on a daily basis?

Is the pain a dull ache? Is it intense? Does it interfere with daily activities? Or can you go on with your day? In all scenarios, you may be suffering from chronic daily headaches (CDH).

Daily headaches are considered chronic when they occur 15 days or more a month for longer than three months. A migraine headache can last one day or more and may occur several times a week or as infrequently as once every few years. CDH can be short term, meaning the pain lasts less than four hours or long term, meaning the pain lasts longer than four hours. Common types of CDH include chronic tension-type headaches, chronic migraines, hemicrania continua  (pain on one side of the face or head) and medication-overuse headaches. 

Since there are over 150 types of headaches, finding out why frequent headaches occur can be difficult. If you have a family history of migraines, your chances of also having migraines increase by approximately 90%.   

Some headaches are caused by  other medical conditions, but they can also be caused by stress, too much or too little sleep, eye strain, hunger, too much alcohol, tobacco or caffeine, or withdrawal from these same chemicals.

People take a host of medications for headache pain, but excessive use of some pain medications can increase the risk of developing medication-overuse headaches. To avoid medication-overuse headaches, avoid medications that contain butalbital and opioids (narcotics), limit the use of triptans (a group of medications for migraines and cluster headaches) or aspirin/acetaminophen/caffeine combinations to less than 10 days per month. Don’t use nonsteroidal anti-inflammatory drugs (NSAIDs) more than 14 days per month.

People go to the emergency department (ED) with head pain every 10 seconds in the U.S., and about 1.2 million ED visits are for acute migraine attacks.

Not all headaches require medical attention, but some headaches are signals of serious conditions, calling for prompt medical care. Seek medical attention if you experience:

• Sudden or severe headaches associated with a stiff neck

• Headaches associated with fever or convulsions, or headaches accompanied by confusion or loss of consciousness

• Headaches after a blow to the head, or headaches associated with pain in the eye or ear

• New, daily persistent headaches when you have previously been headache-free

Preventive treatment is recommended when headaches occur three or more times a month. Here are some tips:

1. Keep a headache diary or use a digital app to keep track of your headache severity, duration and triggers, such as stress or changes in weather conditions. Keep track of the medications you have used and how effective they were. This information can be shared with your healthcare provider, enabling more informed decisions regarding treatment plans.
2. Avoid foods that may trigger your headaches. Make a list of foods eaten before a headache and determine if eliminating those foods reduces or eliminates them.
3. Practicing biofeedback, which requires the use of an instrument that monitors your body's response, such as muscle tension or skin temperature, progressive muscle relaxation or abdominal breathing may help individuals reduce headaches.
4. Generally, taking a pain reliever,  such as aspirin, acetaminophen (Tylenol) or a nonsteroidal anti-inflammatory drug, such as ibuprofen (Motrin or Advil) or naproxen (Naprosyn or Aleve) may be helpful, but be careful not to overuse  them. Your healthcare provider may prescribe other medications to relieve pain immediately, or recommend certain medications for use on a regular basis for preventing future headaches.
5. Lifestyle changes found to decrease the frequency of headaches include quitting smoking, reducing alcohol consumption, reducing or eliminating caffeine, keeping a regular schedule for eating and sleeping and getting exercise several times a week.
    

Establish strong and effective communication with your healthcare provider. They are able to provide a more effective and individualized treatment plan that can be modified to meet your needs currently and in the future.

Clinically reviewed and updated by Nancy Kupka, PhD, RN, May 2022.