Daily Headache Prevention
For most people, a headache is just an occasional bother—a nuisance, easily fixed with a couple of analgesics and a glass of water. But for others, headaches are commonplace, happening all too often, on more days than not.
This type of frequent headache is often called a chronic daily headache. It describes a situation when you experience a headache at least 15 days out of the month, for at least three months. About 4% of the adult population in the U.S. experience a headache that falls into this category.
Rule out other causes.
As the American Migraine Foundation notes, the daily persistent headache is a primary headache syndrome, meaning there’s no other underlying cause. So before diagnosing you with a daily headache, your doctor will also want to rule out secondary causes of headache such as cerebrovascular disease, infections, musculoskeletal disorders, or medication overuse (more on that below). You might need to undergo an MRI or other tests to be sure. If an underlying condition is causing the headache, treatment for that condition may eradicate the headache.
Determine the diagnosis.
Before you can embark on a prevention strategy, you have to know what kind of daily headache you’re dealing with. You may experience short-duration headaches, or you may be dogged by long-duration chronic daily headaches. A typical short-term daily headache might last three or four hours, but a long-duration version will persist longer. There are several major types of long-duration primary chronic daily headaches:
Chronic tension headache. This tends to be the most common version. The pain can be mild to moderate and usually affects both sides of the head.
New daily persistent headache. It starts quickly. People who experience this type of headache can often tell you the exact time the headache started. It can mimic a chronic migraine or a chronic tension-type headache, but it can be harder to treat than either one.
Hemicrania continua. This type of headache is fairly rare, and when it does occur, it tends to occur in women more often than men. It’s sometimes called a continuous headache, since it’s characterized by an ongoing pain occasionally interrupted by a jolt of sharper pain.
Don’t just pop a painkiller.
Tempted to pop a painkiller to ward off a looming headache? Not so fast. You might wind up with a secondary headache known as a medication overuse headache, or rebound headache. These headaches tend to require larger and larger doses of analgesics, even as the medications work less and less effectively. Suddenly you’re taking a lot of medication but still grimacing your way through a headache more often than not. Frequent use of analgesics, taken alone or in combination, is usually the culprit.
Other common characteristics of medication overuse headaches:
Frequency of headaches increases
Nighttime headaches occur
May resemble tension-type headaches, even if the original headache was a migraine
Lower tolerance for stress, which triggers headaches.
Investigate the right medication.
Medication can help, but it can get tricky. The American Headache Society advises being cautious about taking pain relievers to treat your chronic headache pain too often. Your doctor can talk to you about the best way to approach using painkillers, which could include limiting the days that you take them or alternating other medications with them. The type of headache you experience will also determine which painkillers are most likely to work for you.
Your doctor may also advise that you try one of several different types of medication to prevent the onset of your headaches. Depending on the type of daily headache you experience, your doctor might suggest an antidepressant, high blood pressure medications like beta blockers, anti-seizure medications like topiramate, gabapentin, or divalproex sodium, or new CGRP blockers like erenumab (Aimovig), fremanezumab (Ajovy), and galcanezumab (Emgality), which were specifically developed to prevent migraines. Nonsteroidal anti-inflammatory drugs, or NSAIDs, can help if you’re trying to wean yourself off other types of pain relievers.
Try other prevention strategies.
However, many chronic daily headaches are resistant to medication, so you might consider other options for prevention. Some people find their headaches occur less frequently when they take oral magnesium sulfate or coenzyme Q10 supplements, although you’d want to get your doctor’s opinion before giving them a try. Vitamin B2 has also been shown to reduce some migraine headaches. Other people find that cutting back or even eliminating caffeine from their diets has a positive effect.
It’s also worth trying to reduce your stress levels, as stress can exacerbate headaches. Getting a good night’s sleep, fitting regular exercise in your schedule and finding some quiet time to unwind may help you get a handle on your stress. At the very least, those strategies fit into the “can’t hurt, might help” camp and are good for your overall health.
It may take you a while to fight the right combination of strategies for dealing with your daily headaches. If your first attempt doesn’t succeed, talk to your doctor about trying another avenue.