PEDIATRICS

Chronic Daily Headaches / Chronic Migraine

Most people complain of a headache from time to time. However, if you are suffering from a headache every day or at least a few days a week then you could be suffering from chronic daily headaches.

Chronic daily headaches can limit your daily life. Long-term, effective treatment for chronic daily headaches can reduce the frequency and intensity of the headache.

Symptoms

If you suffer from a headache for more than fifteen days per month in at least a three month period then this is a chronic daily migraine. Primary chronic headaches are not caused by another condition.

There are short and long lasting types of chronic daily headaches. Long lasting headaches last for more than four hours every day.

  • 1. Chronic migraine
  • 2. Chronic tension type headache
  • 3. New daily persistent headache
  • 4. Hemicrania continua

1. Chronic migraine

Just as every headache is not a chronic migraine, every headache is not a migraine. Frequently occurring episodic migraines is known as chronic migraines. If the patient suffers for more than 15 days per month in at least three months, if the pain on at least eight days is typical of migraine and if the patient suffers pain for more than four hours then the patient is diagnosed with chronic migraines. Migraines have the following features;

Either one or both sides of your head can be affected

  • Throbbing
  • Moderate to severe pain
  • Aggravated by routine physical activity
  • And can cause at least one of the following:
  • Nausea, vomiting or both
  • Extreme sensitivity to light and sound

2. Chronic tension headaches

These headaches are usually accompanied by mild to moderate pain; and can cause a feeling of pressure which can affect both sides of the head. Some patients experience sensitivity in their scalps. Routine physical activity will not affect or aggravate the pain.

3. New daily persistent headache

These types of headaches occur suddenly in people who have no previous history of headaches. The headache becomes constant within three days. The pain affects both sides of the head and it feels like pressure or tightening (however, not throbbing). The pain is mild to moderate. This type of pain is not aggravated by routine physical activity.

4. Hemicrania continua

This type of headache affects only one side of the head. The pain is steady and daily with no periods of pain-free days. The pain is usually moderate and responds to prescription pain reliever indomethacin. These headaches can become more severe with symptoms similar to migraine.

Hemicrania continua headaches are associated with at least one of the symptoms which can include watery eyes, redness of the eye on the side of the pain, blocked or runny nose, narrowing of the pupil, droopy eyelid or a feeling of anxiety.

When should you visit a doctor?

Occasional headaches do not require a medical intervention and are temporary. However, if a headache lasts more than two days a week which requires one or more pain relief medication or if the headache is worse than usual then you should visit your doctor.

The exact causes of primary chronic daily headaches are unknown and they do not have an underlying cause.

Conditions that may cause non-primary chronic daily headaches can be listed as follows;

  • Problems associated with the blood vessels in and around the brain, strokes
  • Infections such as meningitis
  • Pressure within the skull which is too high or low
  • Brain tumor
  • Traumatic brain injury

Medication overuse headache

This type of headache develops in people who suffer episodic headaches or tension headaches and is associated with taking too much medication. If you are using pain relief medication or analgesics more than two days a week then you are at risk of developing rebound headaches.

Risk factors

Factors which contribute to the development of frequent headaches:

  • Being a woman
  • High levels of anxiety
  • Depression, negativity
  • Sleep disorders
  • Obesity
  • Snoring
  • Excessive consumption of caffeine
  • Excessive use of pain relief medication
  • Other chronic pain conditions

What are its complications?

If you are suffering chronic headaches on a daily basis then you are at risk of developing conditions such as depression, anxiety and sleep disorders.

There are a few things you can do before your doctor’s appointment. For example, you can keep a journal detailing the intensity of your headache, its duration, what you were doing when it started, how long before you took medication, and whether or not there were any prior triggers. You can include observations made by your friends and relatives. You can write down all your personal information including big changes and daily stresses. You can inform your doctor of all medications and vitamins you take, including dosage and frequency.

You can write down the questions you want to ask your doctor. You can ask your doctor the following questions regarding chronic headaches.

  • What is the likely cause of my headache?
  • Is there any other likely cause?
  • Which tests do I need to have?
  • Is my situation temporary or permanent?
  • How can I manage my headaches and other existing health conditions?
  • Do I need to consult a specialist from a different department (Cardiology, Endocrinology, Psychiatry etc.)?

Is there any reading material you could suggest I read? Which websites do you recommend I read? Don’t hesitate to ask your doctor all of your questions.

Treatments

Preventive medication treatments vary depending on what type of headache you have and whether the overuse of medication is contributing to the headache. If you are taking pain relief at least three days per week then the first step in treatment will be for your doctor to offer you options regarding weaning yourself off the medication totally or to reduce the medication you take.