Chronic Headache - what is it and what can you do about it?

By a chronic headache I mean that you experience pain in your head every day or nearly every day.

Knowing your headache diagnosis is a very important step, as there are well over a dozen different causes of chronic daily headache.

There are 2 main categories or types of chronic daily headache;

Firstly, there are frequent short lived headaches - in this situation you will have pain in your head for no more than 4 hours in any headache-day.

Second, there are long duration headaches where almost every minute of every day you are aware of pain in the head.

Please take a minute to read about the difference between short-lived and long-duration chronic headaches.

If you do this you will probably understand better the nature of the problem you have.

Chronic Headache - short-lived episodes (<4 hours per episode)

They are listed in order from most common to least common, and typical duration of a single pain episode:

1. Ice-pick Headaches (seconds)
2. Cluster Headache (15-180 minutes)
3. Trigeminal Neuralgia (seconds to minutes)
4. Exertional or Exercise Induced Headache, including headaches brought on by laughter, coughing, or intercourse
5. Hypnic Headache - go to sleep pain free, waken about the same time most nights with severe headache (15-180 minutes usually)
6. Paroxysmal Hemicrania (up to 5 minutes)
7. Other neuralgias of the face, ear and head (seconds to minutes, and triggered by physical manouvre, such as swallowing, chewing or neck movement
• Glossopharyngeal neuralgia
• Nervus Intermedius neuralgia
• C2 neuralgia
8. SUNCT seconds to minutes - Sudden Unilateral Neuralgiform pain with Conjunctival injection and Tears

Chronic Headache - long duration (>4 hours per day, usually all day)

Again, I have listed them from the ones I see most often to the ones that are more rare:

1. Chronic Migraine. There will have been previous migraine episodes in the past, which may or may not have been diagnosed as such.

   About 2% of people with migraine will change from episodes of migraine to daily, chronic migraine in any given year. Overuse of medication, poor lifestyle and life-stress often happen in the run up to chronic migraine.

   Some people will just get "bad migraine" for no obvious reason - it just happens.

2. Cervicogenic Headache - there is usually a history of neck injury or limited neck movement when examined. The pain is almost always on one side of the head only and usually located at the back of the head.
3. Idiopathic Intracranial Hypertension - most people with this will be overweight, and along side daily headaches (which can vary in intensity), they can get a pulsing or whooshing noise in the head called pulsatile tinnitus
4. Spontaneous Intracranial Hypotension - this causes symptom called postural headache. Pain is releived or nearly releived by lying horizontal, and returns within seconds to minutes of standing up again. Often there is a distortion of hearing with this type of headache.
5. New Daily Persistent Headache - is a difficult to treat headache that starts one day, sometimes associated with a fever, and persists for months, yet does not seem to have features to suggest any other diagnosis.
6. Chronic Tension Type Headache - if you go looking for other causes of headache, tension headache is not a very common diagnosis is my own practice. Part of the reason is that most people with this type of headache are not referred by their GPs, as there is not much that can be done.
7. Carbon Monoxide Poisoning
8. Chronic Jugular Vein Thrombosis - can produce a headache that mimics Idiopathic Intracranial Hypertension

What should I do about Chronic Headaches?

If you keep a headache diary, this can help decide which type of chronic headache you have (short-lived or long duration).

A headache diary can also help see if there is any pattern to headaches eg do they only waken from sleep, or are they only occurring with exercise?

If you have an appointment with a headache specialist or neurologist coming up or are planning on seeing one, arriving with a pre-prepared 1-2 week diary can be really helpful.

It is alos helpful to write a list of different medicines you have tried and why they were stopped.

A list or copies of previous investigations or assessments is also helpful, as it can save time (and money) on repeat tests.

I should also say that anyone with a chronic daily headache should make sure that they ar eliving a headache-friendly lifestyle: the better you look after yourself, physically and mentally, the easier it is to cope with headache.

Do you want to contact me?

Thanks.