Some people have frequent headaches for 16 days or more each month---called chronic daily headache---according to David W. Dodick, M.D., in an article on chronic daily headaches in the New England Journal of Medicine. He says that up to 80 percent of patients of headache clinics have daily or near-daily headaches. Many headaches, whether chronic migraines or chronic tension-type headaches, are caused by medication overuse. Chronic migraines may also be caused by menstruation and allergies. In addition to being caused by overuse of medications, chronic tension-type headaches may also be caused by stress. The daily persistent headache may be caused by infections, allergies and other causes.
Medication-Overuse Headaches
Many frequent headaches are caused by medication overuse. Sometimes termed rebound headaches, medication-overuse headaches are caused by excessive use of headache medication, such as use for greater than three consecutive months, according to Dodick.
In a 2010 article on medication overuse headaches, Drs. Stewart and Deborah Tepper report that medication overuse can happen with the use of butalbital five days a month or opioids eight days per month. They also note overuse of headache medication often triggers neck pain, and patients may seek muscle relaxants for their neck pain, unaware it is generated by head pain.
Medication overuse occurs less frequently with triptan drugs taken by people with migraines because triptans are more effective for migraines than other drugs, say the Teppers.
According to an article by Dr. Stephen D. Silberstein, studies have shown about 70 percent of patients with chronic daily headaches caused by medication overuse respond to intravenous dihydroergotamine mesylate, becoming headache free and remaining free of headaches two years later.
Chronic Migraines
Silberstein says the chronic migraine is also called mixed headache or transformed migraine. Most people with this type of headache are women who have had migraines starting in adolescence or young adulthood. This type of migraine may also be aggravated by menstruation. It develops with medication overuse in about 80 percent of the cases, but can occur without overuse.
In their book, "The Headache Cure," Drs. Joseph Kandel and David Sudderth say studies show cases of individuals with chronic migraines and analgesic overuse are associated with hypertension and asthma. Thus, these two medical problems should be further investigated by physicians. The doctors also noted research shows individuals with chronic migraines and no analgesic overuse may have allergies, hypothyroidism, asthma or hypertension or use caffeine daily, and one or more of these issues should be considered as potential causes of chronic migraines.
Chronic Tension-Type Headaches
The chronic tension-type headache may be an almost constant headache accompanied by chronic fatigue, diminished sexual libido, carbohydrate cravings, and problems with memory and concentration. Unlike non-chronic tension headaches, the patient with chronic tension headaches may have nausea. Chronic tension-type headache is triggered by stress and more common in women.
If the chronic tension headache is related to medication use, it may be caused by overuse of ergotamine or butalbital combinations that include painkillers, as well as combination medications that include caffeine. In contrast, acetaminophen, aspirin and nonsteroidal anti-inflammatory drugs, or NSAIDs, are not believed to cause medication overuse tension-type headaches.
Hemicrania Continua
A rare chronic headache disorder, hemicrania continua, may be caused by irritation of the nerve root at the seventh cervical vertebrae, C7, or by hernation of a disc. Most cases respond to indomethacin.
Daily Persistent Headache
Silberstein says the daily persistent headache is a new headache that suddenly appears and is mild to moderate. The person may experience a sensitivity to light as well as a sensitivity to sound and mild nausea. This type of headache usually occurs in a person without a history of headaches. Physicians should rule out new migraines as well as possible secondary causes, such as a headache caused by viral or bacterial infection.
Kandel and Sudderth say research shows patients with daily persistent headaches may have problems with hypothyroidism, allergies, asthma and/or alcohol consumption more than three times per week.
If a new headache is extremely severe and unlike a headache the person has ever had before, Kandel and Sudderth recommend emergency treatment because this headache could indicate the onset of a stroke. In this case, the individual or others should call 911.
References
- New England Journal of Medicine; Chronic Daily Headache; Avid W. Dodick, M.D; January 12, 2006
- Cleveland Clinic Journal of Medicine; Breaking the Cycle of Medication Overuse Headache; Stewart J. Tepper, M.D., and Deborah E. Tepper, M.D.; April 2010
- Journal of the American Osteopathic Association; Chronic Daily Headache; Stephen D. Silberstein, M.D.; April 2005
- "The Headache Cure"; Joseph Kandel, M.D., and David Sudderth, M.D.; 2005
