Chronic daily headaches By Mayo Clinic staff

Transcription

1 Chrnic daily headaches By May Clinic staff Original Article: Definitin Mst peple have headaches frm time t time. But if yu have a headache mre days than nt, yu may be experiencing a variety f head pain knwn as chrnic daily headaches. The incessant nature f chrnic daily headaches makes them amng the mst disabling headaches. Aggressive initial treatment and steady, lng-term management may reduce pain and lead t fewer chrnic daily headaches. Symptms By definitin, chrnic daily headaches must ccur 15 days r mre a mnth, fr at least three mnths. And t be cnsidered true (primary) chrnic daily headaches, they must als nt be the result f anther cnditin. Chrnic daily headaches are classified by hw lng they last mre than fur hurs r less than fur hurs. The lnger lasting headaches are mre cmmn and addressed here. They're divided int fur types: Chrnic migraine Chrnic tensin-type headache New daily persistent headache Hemicrania cntinua

2 Chrnic migraine These headaches evlve frm episdic migraine withut aura. T be diagnsed with chrnic migraine, yu must have headaches migraine, tensin-type r bth 15 days r mre a mnth, fr at least three mnths. In additin, n eight r mre days a mnth fr at least three mnths, yu must experience the fllwing symptms. Yur headaches have at least tw f the fllwing characteristics: Affect nly ne side f yur head Cause a pulsating, thrbbing sensatin Cause mderate t severe pain Are aggravated by rutine physical activity And they cause at least ne f the fllwing: Nausea, vmiting r bth Sensitivity t light and sund Alternatively, if yur headaches respnd t triptan medicatins r ergt medicatins taken in anticipatin f these symptms n eight r mre days a mnth, fr at least three mnths they're als cnsidered chrnic migraines. Chrnic tensin-type headache These headaches evlve frm episdic tensin-type headaches. They may last hurs r be cnstant. Chrnic tensin-type headaches have at least tw f the fllwing characteristics: Hurt n bth sides f yur head Cause mild t mderate pain Cause pain that feels pressing r tightening, but nt pulsating Aren't aggravated by rutine physical activity In additin, they cause n mre than ne f the fllwing: Sensitivity t light r sund Nausea (mild nly)

3 New daily persistent headache These headaches becme cnstant within a few days f the mment yu have yur first headache. New daily persistent headaches have at least tw f the fllwing characteristics: Hurt n bth sides f yur head Cause pain that feels like pressing r tightening, but nt pulsating Cause mild t mderate pain Aren't aggravated by rutine physical activity In additin, they cause n mre than ne f the fllwing: Sensitivity t light r sund Nausea (mild nly) Hemicrania cntinua These headaches cause pain n nly ne side f yur head that desn't shift sides. They als: Are daily and cntinuus with n pain-free perids Cause mderate pain but with spikes f severe pain Respnd t the prescriptin pain reliever indmethacin (Indcin) May smetimes becme severe with develpment f migraine-like symptms In additin, hemicrania cntinua headaches cause at least ne f the fllwing: Tearing r redness f the eye n the affected side Nasal cngestin r runny nse Drping f the eyelid r cnstrictin f the pupil

4 When t see a dctr Occasinal headaches are cmmn. But it's imprtant t take headaches seriusly. Cnsult yur dctr if: Yu usually have tw r mre headaches a week. Yu take a pain reliever fr yur headaches every day r almst every day. Yu need mre than the recmmended dse f ver-the-cunter pain remedies t relieve yur headaches. Yur headache pattern changes. Yur headaches are getting wrse. Seek prmpt medical care if yur headache: Is sudden and severe Accmpanies a fever, stiff neck, cnfusin, seizure, duble visin, weakness, numbness r difficulty speaking Fllws a head injury Gets wrse despite rest and pain medicatin Causes The causes f many chrnic daily headaches aren't well understd. True (primary) chrnic daily headaches dn't have an identifiable underlying cause. Sme pssible factrs may include: Yu've develped a heightened respnse t pain signals. The part f yur brain that suppresses pain signals isn't wrking prperly. Other frequent headaches may be caused by varius underlying diseases r cnditins, including: Inflammatin r ther prblems with the bld vessels in and arund the brain, including strke Infectins, such as meningitis Intracranial pressure that's either t high r t lw Brain tumr Traumatic brain injury Many peple wh have frequent headaches are actually experiencing a rebund effect frm taking pain medicatin t ften. If yu're taking pain medicatins even ver-the-cunter analgesics mre than three days a week (r nine days a mnth), yu're at risk f develping rebund headaches.

5 Risk factrs Varius factrs are assciated with develping frequent headaches, including: Anxiety Depressin Sleep disturbances Obesity Snring Overuse f caffeine Overuse f pain medicatin Regular use f physical pstures that put a strain n yur head r neck Cmplicatins If yu have chrnic daily headaches, yu're als mre likely t experience depressin, anxiety, sleep disturbances, and ther psychlgical and physical prblems. Preparing fr yur appintment Yu're likely t start by first seeing yur family dctr r a general practitiner. Hwever, in sme cases when yu call t set up an appintment, yu may be referred t a headache specialist. Because appintments can be brief, and because there's ften a lt f grund t cver, it's a gd idea t be well prepared fr yur appintment. Here's sme infrmatin t help yu get ready fr yur appintment, and knw what t expect. What yu can d Be aware f any pre-appintment restrictins. At the time yu make the appintment, be sure t ask if there's anything yu need t d in advance, such as restrict yur diet. Keep a headache jurnal, which shuld include when each headache ccurred, hw lng it lasted, hw intense it was, what yu were ding immediately befre the headache started, and anything else that was ntable abut the headache. Write dwn any symptms yu're experiencing, including any that may seem unrelated t the reasn fr which yu scheduled the appintment. Write dwn key persnal infrmatin, including any majr stresses r recent life changes.

6 Make a list f all medicatins, vitamins r supplements that yu're taking. Take a family member r friend alng, if pssible. Smene wh accmpanies yu may remember smething that yu missed r frgt. Write dwn questins t ask yur dctr. Yur time with yur dctr is limited, s preparing a list f questins will help yu make the mst f yur time tgether. List yur questins frm mst imprtant t least imprtant in case time runs ut. Fr chrnic headaches, sme basic questins t ask yur dctr include: What is likely causing my headaches? Are there ther pssible causes fr my headaches? What kinds f tests d I need? Is my cnditin likely temprary r chrnic? What is the best curse f actin? What are the alternatives t the primary apprach that yu're suggesting? I have these ther health cnditins. Hw can I best manage them tgether? Are there any restrictins that I need t fllw? Shuld I see a specialist? What will that cst, and will my insurance cver seeing a specialist? Is there a generic alternative t the medicine yu're prescribing me? Are there any brchures r ther printed materials that I can take hme with me? What websites d yu recmmend? In additin t the questins that yu've prepared t ask yur dctr, dn't hesitate t ask questins during yur appintment. What t expect frm yur dctr Yur dctr is likely t ask yu a number f questins. Being ready t answer them may reserve time t g ver any pints yu want t spend mre time n. Yur dctr may ask: When did yu first begin experiencing headaches? Have yur headaches been cntinuus r ccasinal?

7 Hw severe are yur headaches? What, if anything, seems t imprve yur headaches? What, if anything, appears t wrsen yur headaches? What yu can d in the meantime There are sme things yu can d befre seeing yur dctr t try t imprve yur headache pain: Avid activities that yu knw make yur headaches wrse. Try ver-the-cunter pain-relief medicatins such as naprxen (Aleve) and ibuprfen (Advil, Mtrin, thers). Dn't take these mre than three times a week, because that may make yur headaches wrse. Tests and diagnsis Yur dctr will prbably d a physical exam t check fr signs f illness, infectin r neurlgical prblems. If the cause f yur headaches remains uncertain, yu may need bld r urine tests t identify any underlying medical cnditins. Smetimes imaging studies such as a cmputerized tmgraphy (CT) scan r magnetic resnance imaging (MRI) scan are recmmended. An electrencephalgram (EEG) can als help diagnse brain tumrs, injury r inflammatin. Treatments and drugs Treatment fr any underlying diseases r cnditins ften stps frequent headaches. When n underlying diseases r cnditins are present, treatment fcuses n preventing the pain befre it starts. Specific preventin strategies vary, depending n which type f headache yu have and whether medicatin veruse is cntributing t these headaches. If yu're taking pain relievers mre than three days a week, the first step in treatment may be t stp using these drugs. When yu're ready t begin preventive therapy, yur dctr may recmmend: Antidepressants. Tricyclic antidepressants such as nrtriptyline (Pamelr, Aventyl Hydrchlride) can be used t treat chrnic headaches. These medicatins can als help treat the depressin, anxiety and sleep disturbances that ften accmpany chrnic daily headaches. Other antidepressants, such as the selective sertnin reuptake inhibitr (SSRI) fluxetine (Przac, Sarafem), may be helpful fr treatment f depressin and anxiety, t. Beta blckers. These drugs, cmmnly used t treat high bld pressure, are als a mainstay fr preventing episdic migraines. Sme beta blckers include atenll (Tenrmin), metprll (Lpressr, Tprl-XL) and prpranll (Inderal, Innpran XL). Smetimes beta blckers are

8 prescribed in cmbinatin with antidepressants, and this cmbinatin is smetimes mre effective than either medicatin n its wn. Anti-seizure medicatins. Sme anti-seizure drugs seem t prevent migraines. These medicatins may be used t prevent chrnic daily headaches as well. Optins may include gabapentin (Neurntin, Gralise), tpiramate (Tpamax) and divalprex sdium (Depakte). NSAIDs. Prescriptin nnsteridal anti-inflammatry drugs such as naprxen (Anaprx, Naprsyn, Naprelan) may be helpful, especially if yu're ging thrugh withdrawal frm ther pain relievers. They may als be used peridically when the headache is mre severe. Btulinum txin. Btulinum txin type A (Btx) injectins prvide relief fr sme peple and may especially be a viable ptin fr peple wh dn't tlerate daily medicatin well. Unfrtunately, sme chrnic daily headaches remain resistant t all medicatins. Alternative medicine Fr many peple, cmplementary r alternative therapies ffer welcme relief frm headache pain. It's imprtant t be cautius, hwever. Nt all cmplementary r alternative therapies have been studied as headache treatments, and thers need further research. Acupuncture. This ancient technique uses hair-thin needles inserted int several areas f yur skin at defined pints. Studies have shwn that acupuncture helps reduce the frequency and intensity f chrnic headaches. Bifeedback. Bifeedback may be beneficial in treating headaches. In bifeedback, yu can learn t cntrl headaches by becming mre aware f and then changing certain bdily respnses such as muscle tensin, heart rate and skin temperature. Meditatin. Practicing meditatin can help yu relax physically and remain calm mentally. The practice creates a deeply restful state in which yur breathing slws and yur muscles relax which can help yu manage pain and reduce stress. Massage. Massage can reduce stress, relieve pain and prmte relaxatin. Althugh its value as a headache treatment hasn't been determined, massage may be particularly helpful if yu have tight, tender muscles in the back f yur head, neck and shulders.

9 Herbs, vitamins and minerals. Sme evidence exists that the herbs feverfew and butterbur may prevent migraines r reduce their severity. A high dse f ribflavin (vitamin B-2) als may prevent migraines by crrecting tiny deficiencies in brain cells. Cenzyme Q10 supplements may be helpful in sme individuals. And ral magnesium sulfate supplements may reduce the frequency f headaches in sme peple, althugh studies dn't all agree. Ask yur dctr if these treatments are right fr yu. Dn't use ribflavin (vitamin B-2), feverfew r butterbur if yu're pregnant. Electrical stimulatin f the ccipital nerve. A small battery-pwered electrde is surgically implanted near the ccipital nerve, which is at the base f yur neck. The electrde sends cntinuus energy pulses t the nerve t ease pain. This apprach is investigatinal and has shwn sme gd results but is nt a standard therapy. If yu'd like t try a cmplementary r alternative therapy, discuss the risks and benefits with yur dctr. Cping and supprt Chrnic daily headaches can interfere with yur jb, yur relatinships and yur quality f life. But yu can cpe with the challenges. Take cntrl. Cmmit yurself t living a full, satisfying life. Wrk with yur dctr t develp a treatment plan that wrks fr yu. Take gd care f yurself. D things that lift yur spirits. Set aside time fr yur lved nes and yurself every day. Seek understanding. Dn't expect friends and lved nes t instinctively knw what's best fr yu. Ask fr what yu need, whether it's time alne r less attentin fcused n yur headaches. Check ut supprt grups. Yu may find it useful t talk t ther peple wh experience painful headaches. Try finding a supprt grup in yur area t learn hw ther peple cpe with their headache pain and discmfrt. Cnsider cunseling. A cunselr r therapist ffers much needed supprt and can help yu manage stress. Yur therapist can als help yu understand the psychlgical effects f yur headache pain.

10 Preventin Taking gd care f yurself can help prevent chrnic daily headaches. Avid headache triggers. If yu're nt sure what triggers yur headaches, keep a headache diary. Include details abut every headache. When did it start? What were yu ding at the time? What did yu eat that day? Hw did yu sleep the night befre? What was yur stress level? Hw lng did the headache last? What, if anything, prvided relief? Eventually, yu may begin t see a pattern and be able t take steps t prevent future headaches. Avid medicatin veruse. Taking headache medicatins, including ver-the-cunter medicatins, mre than twice a week can actually increase the severity and frequency f yur headaches. If yu are taking medicatin t ften, it is imprtant t cnsult yur dctr abut hw best t wean yurself ff the medicatin because there can be serius side effects if dne imprperly. Get enugh sleep. The average adult needs seven t eight hurs f sleep a night. It's best t g t bed and wake up at regular times, as well. Dn't skip meals. Start yur day with a healthy breakfast. Eat lunch and dinner at abut the same time every day. Avid any fd r drinks, such as thse cntaining caffeine, that seem t trigger headaches. Exercise regularly. Regular aerbic physical activity can imprve yur physical and mental wellbeing. Exercise als helps reduce stress. With yur dctr's OK, chse activities yu enjy such as walking, swimming r cycling. T avid injury, start slwly. Reduce stress. Stress is a cmmn trigger f chrnic headaches. Get rganized. Simplify yur schedule. Plan ahead. Stay psitive. Mst headaches caused by stress end when the perid f stress is ver. Relax. Try yga, meditatin r relaxatin exercises. Set aside time t slw dwn. Listen t music, read a bk r take a ht bath. Reduce yur caffeine. While sme headache medicatins include caffeine because it can be beneficial in reducing headache pain, it can als aggravate headaches. Try t minimize, r better yet, eliminate caffeine frm yur diet. DS00646 March 15, May Fundatin fr Medical Educatin and Research (MFMER). All rights reserved. A single cpy f these materials may be reprinted fr nncmmercial persnal use nly. "May," "May Clinic," "MayClinic.cm," "EmbdyHealth," "Enhance yur life," and the triple-shield May Clinic lg are trademarks f May Fundatin fr Medical Educatin and Research.