Troubleshooting constant headaches

Image: iStock

Almost everyone gets a headache from time to time. Some people, though, get them daily or almost every day. This problem is known as chronic daily headache. Women are twice as likely as men to have it.

People with this condition get headaches every day or nearly every day for a prolonged period of time – for example, at least five days a week for a year or longer. Most often, chronic daily headaches develop in people who used to get the occasional migraine, tension headache, or other type of headache. Sometimes chronic daily headache develops without any preamble or warning.

Get your copy of Headaches

Headaches inflict their misery in a variety of ways, from a dull, steady ache to a blinding, throbbing pain. Nearly everyone has them at least occasionally, but an unfortunate few experience near-constant head pain. This report offers in-depth information on the most common kinds of headaches and the treatment strategies that work best for each, including a number of self-help and alternative techniques.

No matter how it originates, chronic daily headaches are notoriously difficult to treat and, understandably, often produce anxiety and depression.

Getting control of chronic daily headaches often means weaning off regular use of pain relievers. Consider other methods to help ease headache pain, too. For example, try a cool compress on the forehead or a heating pad on tight muscles in the neck. You may want to ask your doctor to send you to a physical therapist. Techniques such as massage, ultrasound, and relaxation exercises may also help keep headaches at bay.

Preventive medications are a good choice for some people. Examples include a tricyclic antidepressant such as amitriptyline (Elavil) or nortriptyline (Pamelor, Aventyl), a beta blocker such as propranolol (Inderal) or nadolol (Corgard), or gabapentin (Neurontin). For some people who suffer with chronic daily headaches, other medications may be necessary. As with many chronic conditions, it is important to work closely with your doctor to find the preventive and treatment strategies that work for you.

For more on preventing and treating headaches, buy Headaches, a Special Health Report from Harvard Medical School.

Short circuit migraines before they start

Author and migraine sufferer Joan Didion once wrote, "That no one dies of migraine seems, to someone deep into an attack, an ambiguous blessing." At that time, migraines weren't something that could be prevented. Today, that's a possibility for some people who have severe migraines, frequent migraines (more than three or four times a month), or migraines that don't respond well to treatment.

The cornerstone of migraine prevention is managing triggers like stress or certain foods or strong perfumes. Alternative and complementary therapies (like acupuncture) help some migraine sufferers keep headaches at bay.

In some cases, taking medication even when you aren't having a migraine attack can help. This usually involves taking the medication every day, with the goal of gradually tapering the dose, and, ideally, eventually discontinuing it altogether. Here are some of the medications commonly used to prevent migraine. Because they have different effects, and potential side effects, it's important to work with your doctor to find the one that's right for you.

Beta blockers

Commonly prescribed for high blood pressure, abnormal heart rhythms, and heart-related chest pain, beta blockers may prevent migraines by not allowing blood vessels to expand too much (and put pressure on nerves). There are many beta blockers available, and it may take a while to find the one that works best for you.

Tricyclic antidepressants

These medications are sometimes used to help manage pain, including headache. Amitriptyline (Elavil, Endep) is the best studied for pain relief and the most often prescribed for migraine prevention: it's about 60% effective in thwarting such headaches.

Calcium-channel blockers

Calcium-channel blockers are also used primarily for treatment of high blood pressure and heart-related conditions, but help some people prevent migraine.

Anti-seizure medications

Topiramate (Topamax) and divalproex (Depakote) are anti-seizure drugs that are also specifically approved for migraine prevention. Gabapentin (Neurontin) is another that, while not specifically approved to prevent migraines, does work well for some people.

Other drugs

Although low-dose aspirin is far less effective than the standard migraine headache preventive medications, it may improve migraine control when used in combination with another preventive medication. It is important to check with your doctor before starting to take aspirin daily.

For more information on preventing, diagnosing and treating migraines and other types of headache, buy Headaches: Relieving and Preventing Migraine and Other Headaches, a Special Health Report from Harvard Medical School.

Headaches

Featured content:

•	Headache basics
•	Self-help and alternative strategies to ease headache pain
•	Tension headache
•	Migraine headache
•	SPECIAL BONUS SECTION: Mitigating migraine pain: Past, present, and future
•	... and more!