ConditionBrain & nerves
Chronic Headaches (Chronic Daily Headache)
Chronic headaches are headaches that occur on 15 or more days a month for at least 3 months. They affect about 3 to 5 in 100 adults. Most are chronic migraine, chronic tension-type headache or medication overuse headache, which happens when painkillers for headaches are taken too often. Chronic headaches are rarely caused by a serious disease, but certain warning signs need prompt checks. Effective treatment combines preventive medicines, cutting back painkillers and addressing sleep, stress and other triggers.
Also called: Chronic daily headache, persistent headaches, frequent headaches, daily headaches
At a glance
- Definition
- Headache on 15 or more days a month for more than 3 months.
- Main types
- Chronic migraine, chronic tension-type headache, medication overuse headache, new daily persistent headache, hemicrania continua.
- Common driver
- Using painkillers or triptans on too many days a month.
- Diagnosis
- Mostly from history and examination; scans only when there are red flags.
- Treatment
- Preventive medicines, limiting acute painkillers, and lifestyle and psychological approaches.
When to get help
Call 911 or go to the ER
- A sudden, explosive headache reaching full intensity within a minute ("worst headache of my life")
- Headache with weakness, numbness, facial droop, confusion, slurred speech or loss of vision
- Headache with fever, stiff neck, rash or confusion
- Headache after a head injury, especially with vomiting or drowsiness
See a doctor within a day or two
- A new headache after age 50, or one that keeps getting worse over days to weeks
- Headache with jaw pain on chewing, scalp tenderness or vision changes in someone over 50 (possible giant cell arteritis)
- Headache that is much worse lying down or on waking, with vomiting
- Headache with very high blood pressure, such as 180/120 or higher
- Headache in someone with cancer or a weakened immune system
Book a routine appointment
- Headaches on more than 8 to 10 days a month
- Using painkillers for headaches more than 2 to 3 days a week
- Headaches changing in pattern or frequency
- Morning headaches with snoring or daytime sleepiness
What counts as chronic headache
Doctors use chronic daily headache as an umbrella term for any headache disorder that occurs on 15 or more days a month. Identifying the specific type is essential because treatments differ.
| Type | Features |
|---|---|
| Chronic migraine | Headache on 15+ days a month, at least 8 with migraine features (throbbing, one-sided, nausea, light and sound sensitivity, worse with activity) |
| Chronic tension-type headache | Pressing or tightening, both sides, mild to moderate, not worsened by activity, little nausea |
| Medication overuse headache | Develops in someone with a headache disorder who takes acute medicines too often |
| New daily persistent headache | Daily from a clearly remembered start, often after an infection or stressful event |
| Hemicrania continua | Constant one-sided headache with eye watering or redness on that side; responds completely to indomethacin |
| Chronic cluster headache | Severe one-sided pain around the eye, attacks lasting 15 minutes to 3 hours, without long remission periods |
Medication overuse headache
This is one of the most common and treatable causes of chronic headache. It develops when acute headache medicines are taken on too many days:
- simple painkillers (acetaminophen, ibuprofen, aspirin) on 15 or more days a month
- triptans, combination painkillers or opioids on 10 or more days a month
The brain becomes more sensitive to pain, and headaches become more frequent. Stopping or sharply reducing the overused medicine, usually with a preventive treatment started at the same time, leads to improvement within weeks to months for many people. Headaches often get worse for the first 1 to 2 weeks before they improve.
Causes and risk factors
- an existing migraine or tension-type headache that becomes more frequent
- frequent use of acute headache medicines
- caffeine overuse (more than about 200 to 300 mg a day) or caffeine withdrawal
- poor sleep, insomnia and obstructive sleep apnea
- depression, anxiety and chronic stress
- obesity
- hormonal changes
- neck and jaw problems (temporomandibular disorders)
Secondary causes
Less commonly, chronic headaches come from another condition:
- high pressure in the brain (idiopathic intracranial hypertension), mainly in young women, with visual changes
- low spinal fluid pressure, causing headache that is worse upright
- giant cell arteritis in people over 50
- very high blood pressure, including hypertensive encephalopathy
- brain tumors, which are a rare cause and usually have other neurological signs
- medicines such as nitrates
Diagnosis
A headache diary is the most useful tool. Record each headache day, its severity, features, triggers and every medicine taken, for at least 4 to 8 weeks.
Your doctor will take a detailed history and examine your nervous system, eyes (including the back of the eye) and blood pressure. Most people with chronic headache and no red flags do not need a brain scan. MRI or CT is used when there are warning signs, an abnormal examination, or an unusual pattern. Blood tests may be done for giant cell arteritis, and a sleep study for suspected sleep apnea.
Treatment
Reducing acute medicine use
Limit painkillers to no more than 2 to 3 days a week. If medication overuse is present, your doctor will guide you in stopping or tapering it.
Preventive medicines
Taken daily or monthly to reduce headache frequency:
- for chronic migraine: topiramate, propranolol, amitriptyline, candesartan, CGRP monoclonal antibodies (monthly or quarterly injections or infusion), gepants, and onabotulinumtoxinA (Botox) injections every 12 weeks
- for chronic tension-type headache: amitriptyline is the most studied
Preventives usually take 2 to 3 months to show their full effect.
Non-drug approaches
- regular sleep, meals and hydration
- regular aerobic exercise
- cognitive behavioral therapy, relaxation training and biofeedback
- physical therapy for neck and shoulder tension
- treating sleep apnea, depression and anxiety
- limiting caffeine to a consistent, moderate amount
Outlook
Chronic headaches can be very disabling, but most people improve substantially with the right diagnosis and a combined treatment plan. Breaking medication overuse alone can convert chronic headaches back to occasional ones. A headache specialist can help when first-line treatments do not work.
Frequently asked questions
What causes daily headaches?
The most common causes are chronic migraine, chronic tension-type headache and medication overuse headache. Poor sleep, sleep apnea, stress, depression, caffeine and hormonal changes contribute. Rarely, daily headaches are caused by raised brain pressure, arteritis or a brain tumor.
Can taking painkillers cause headaches?
Yes. Taking painkillers on 15 or more days a month, or triptans or combination painkillers on 10 or more days, can cause medication overuse headache. Reducing or stopping them, with a preventive treatment, usually improves headaches within weeks to months.
When should I worry about a headache that won't go away?
Seek urgent care for a sudden severe headache, a headache with weakness, confusion, vision loss, fever and stiff neck, or one after a head injury. See a doctor soon for a new headache after 50, steadily worsening headaches, or headaches worse lying down.
How are chronic headaches treated?
Treatment combines limiting acute painkillers, a daily or monthly preventive medicine chosen for the headache type, and lifestyle and psychological approaches such as regular sleep, exercise and CBT. A headache diary helps track progress.
Sources
This guide was written from current patient and clinical guidance, including:
- International Headache Society: International Classification of Headache Disorders, 3rd edition (ICHD-3)
- American Headache Society: Consensus statement on integrating new migraine treatments into clinical practice
- NICE Guideline CG150: Headaches in over 12s: diagnosis and management
- National Institute of Neurological Disorders and Stroke: Headache
- MedlinePlus: Headache