Chronic Headaches - Causes, Types, Diagnosis, and Treatment

What Are Chronic Headaches?

Chronic headaches are also called constant daily headaches, as they happen almost daily in an individual. This means one suffers a headache for at least fifteen days a month. On average, the headache lasts for a minimum of four hours per day, and symptoms range from mild to moderate headaches like tension headaches or severe ones like migraines. The pain can be anywhere in the head, neck, or facial region. Chronic headaches can be quite disabling for someone due to their ongoing nature and severity. Most headaches have other symptoms, which add to one’s suffering.

What Are the Causes of Chronic Headaches?

Most chronic headaches in the general population belong to the primary headache category. They are:

• Migraine headache that occurs only on one side of the head.

• Tension headache, which is felt as tightness around the head.

• Cluster headache, which is felt around the eye (orbit) area.

• Hemicrania continua, similar to migraine headaches, occurs on one side of the head.

• A new daily persistent headache starts suddenly in an individual and persists for weeks and months.

• Changes in the hormone levels in the body cause hormonal headaches.

• Rebound headache due to overuse of pain-relieving medication.

• Exertional headaches are triggered due to any activities involving physical excretion.

What Are the Common Types of Chronic Headaches?

Let us look at the most common types of chronic headaches affecting the general population:

1. Migraine Headache - It is a disorder that causes recurrent headache attacks that come and go. The location of a migraine is mostly only one side of the head (unilateral). The headache starts mild and becomes severe and intense gradually. After continuous episodes of migraine attacks, one may experience a remission period without headaches. And it starts again. Left untreated, the frequency of migraine episodes increases in number, and periods of remission come down to a point where one has headache episodes every day of the year. One migraine attack may last for four to seventy-two hours. One may also suffer nausea, vomiting, inability to tolerate lights and sounds (photophobia and phonophobia), and aura. An aura is a feeling that something is about to happen, which is nothing but the start of an intense headache. In most individuals, the headache is triggered by external factors like food, lifestyle, habits, or activity.

2. Tension Headache - It is more of a muscular type of headache. This is the most common type of headache and one of the biggest reasons people buy over-the-counter analgesics everywhere. The pain is felt around the forehead area on both sides of the head (bilateral). One may experience it as a pressure or tightness on the head, like having a tight band tied around the head that waxes and wanes. The duration of pain is variable. And usually, no other symptoms will be felt apart from the headache.

3. Cluster Headaches - These are the most painful of all chronic headaches. They come and go as a group of headaches, and the reason is unknown. Doctors believe the headache is associated with the trigeminal nerve (the fifth cranial nerve from the brain that gives sensation and movement to various face parts). The cluster headaches are always located on one side of the head and focus on the area around the eye. The pain starts suddenly without any warning signs, as in a migraine. And it is a deep continuous pain of excruciating nature and explosive in quality. The pain starts quickly and ends quickly, lasting for about thirty seconds to three hours. Along with the pain, one may have trigeminal nerve problems as well. On the painful side of the face and head, one may have droopy eyelids and shrunken pupils. The affected eye keeps tearing up, and one may suffer a runny nose the entire time.

4. Hemicrania Continua - The term hemicrania suggests the headache affects only one-half of the head. And it is a continuous type of pain without any pain-free times in between. One may suffer a mild to moderate ache all the time with occasional episodes of increase in severity. On the painful side of the head, one may suffer a stuffy nose, narrow pupils, droopy eyelids, and red-rimmed watery eyes throughout.

5. New Daily Persistent Headaches - This type of headache suddenly starts in an individual with absolutely zero history of previous headaches. After multiple episodes of pain in the first three days of onset, it becomes a persistent one that never goes away. One may experience it as a mild to moderate tightness or squeeze on the head. And the pain is felt on both sides.

6. Hormonal Headaches - Occur when changes in the body's hormonal levels. For instance, in women, a change in the hormone estrogen levels may initiate headaches at the beginning of a menstrual cycle. Also, when somebody undergoing hormone therapy stops taking their daily doses, it may cause a headache.

7. Rebound Headache - This is caused by medication overuse. Mostly seen in individuals suffering from long-lasting migraine headaches. After a certain period, headaches like migraine tend to increase in frequency and severity (chronic migraine). This forces the affected individual to consume over-the-counter pain-relieving medications in excess. They might help relieve the pain to a certain extent, but beyond a limit, the headache comes back more intense and severe with a marked worsening of symptoms.

8. Medication Overuse Headaches - They can be due to mixing up different types of pain medicines as well. One may also develop an unhealthy dependence, drug tolerance, or addiction to the medication to the point withdrawing the medication may intensify the headaches. Apart from these, headaches can be due to side effects from the drugs on the liver, kidneys, or digestive tract.

9. Exertional Headache - Usually, it starts when one performs heavy physical activities all of a sudden. The headache can be triggered by high-intensity cardiovascular exercises, weight lifting, or resistance training that may strain the head. Doctors advise holding a warm-up session to avoid such headaches. In those who suffer from constipation, excessive toilet pressure might trigger a headache. Some may get severe headaches from sexual intercourse also, which are called orgasmic headaches.

What Are the Other Types of Headaches One May Suffer?

Headache may come as a symptom of some other medical condition involving the brain. Such headaches are called secondary headaches. Most of the time, one may show visible neurological symptoms along with headaches such as seizures, altered behavior, vision problems, weakness, tingling, or numbness over the body parts. They can be:

• Headache from a head injury or trauma to the head. The pain will be severe in nature, and one may have a concussion, skull fracture, or active bleeding inside the brain.

• Headache and neck stiffness from an inflammation of the brain or meninges (the covering layers of the brain). The inflammation increases the pressure inside the head, causing severe headaches.

• Headaches from bleeding inside the brain are caused by an aneurysm rupture (ballooning up of blood vessels inside the brain, which may burst over time) or the formation of massive blood clots inside the brain.

• Headaches from a growing mass like a tumor inside the brain, which compresses the adjacent structures inside the brain.

• A sinus infection known as sinusitis may cause a sinus headache that involves the eyes, forehead, cheeks, and upper teeth region.

• Long-term psychological and emotional stress may also induce long-standing headaches in an individual.

How Are Chronic Headaches Clinically Diagnosed?

The doctor is going to review the affected individual’s medical history and the medical background of one’s family. Most types of chronic headaches have similar symptoms, so the doctor needs to understand the pattern of headache episodes to reach the right diagnosis. One may ask for details on the frequency, duration, location, intensity, additional symptoms, what enhances the pain, and what relieves the pain. After doing a physical examination, the doctor may order certain diagnostic tests to rule out the presence of another disease that may cause a headache. One may conduct:

1. Neurological examination to evaluate the brain function to see if the underlying cause of headache also affects the individual's brain function. If yes, then one may require imaging studies for further evaluation.

2. Imaging studies such as magnetic resonance imaging (MRI) and computed tomography (CT) scans visualize the brain's internal structures.

3. An electroencephalogram (EEG) is used to evaluate any possible abnormalities in the brain’s electrical activity.

4. If the doctor feels the headache is due to increased pressure inside the head from an infection or bleeding, one may conduct a lumbar puncture (spinal tapping procedure to collect a clear fluid called cerebrospinal fluid from the spinal column) as well.

How Are Chronic Headaches Treated?

If the doctor suspects the headache is caused by an underlying disease in the brain, like an infection or brain tumor, the individual may need immediate attention, including medical and surgical treatment. In the case of head traumas, the brain should be relieved of the excess pressure and inflammation. For primary headaches, which cause chronic headaches, the following treatments are adopted:

• For migraine-related headaches, the doctor may prescribe drugs, like Amitriptyline, Propranolol, or Topiramate, to prevent or reduce the frequency of migraine episodes. At the time of a headache, one may take Aspirin or other over-the-counter pain medicines. Along with these, one may also need drugs to stop vomiting (Antiemetics). By identifying the individual triggers that induce a migraine attack, an individual can prevent them to a great extent.

• Tension headaches are the most common type of headaches people buy and use pain relievers for. One may take over-the-counter drugs like Paracetamol to relieve the symptoms.

• For cluster headaches, doctors usually prescribe drugs from the category triptans, such as Sumatriptan or Almotriptan, and antiemetic drugs to stop the vomiting. Triptans may be bad for patients with heart and blood vessel disorders.

• For sinus headaches, one may need antibiotics, depending on the cause of the sinusitis, along with pain relievers.

• Headache due to hemicrania continua responds well to the anti-inflammatory medicine Indomethacin.

• Apart from drugs, one may also try psychotherapy and counseling to reduce stress and adopt better ways to cope with tension and anxiety. Applying cold packs and massaging the head also help relieve the symptoms. Monitoring and regulating the body’s functions with a biofeedback mechanism can be useful for some types of headaches. Also, one may adopt electrical nerve stimulation techniques for relieving migraines and cluster headaches.

Conclusion:

Chronic headaches are not easy to live with. But understanding the type and pattern of headaches with the help of a doctor makes them easier to manage. Sometimes, simple lifestyle changes involving getting adequate sleep, eating meals on time, regular exercise, and avoiding the triggers themselves may bring great relief. One may have to quit smoking, alcohol usage, and excess intake of caffeine as well. And if one experiences a sudden worsening in the pattern of headache, do not delay in getting medical attention.