Chronic Daily Headaches : Causes-Symptoms-Diagnosis-Treatment

 What are Chronic Daily Headaches?

Chronic daily headache is outlined because the presence of a headache on fifteen days or a lot per month for a minimum of 3 months. The foremost common forms of chronic daily headache are chronic migraines and chronic tension-type headaches. If a red flag for a secondary reason for headache is present, resonance imaging of the pinnacle ought to be performed. All patients should be asked regarding medication overuse, which may increase the frequency of headaches. Patients who overuse medications for unsuccessful medical care for headache should be inspired to prevent the medications entirely and think about prophylactic treatment. Many prophylactic treatments for chronic daily headache will cut back headache frequency and severity, moreover as improve overall quality of life.

Chronic Daily Headaches

Nonpharmacologic treatments embrace relaxation techniques, psychological feature behavior therapy, acupuncture, osteopathic manipulation, and cervical exercises. medical specialty therapies include amitriptyline, gabapentin, onabotulinumtoxinA, propranolol, tizanidine, topiramate, and valproate.Chronic Daily Headache could be a descriptive term that features disorders with headaches on more days than not and affects 4% of the overall population. The condition includes an enfeebling result on people and society through direct value to attention and indirectly to the economy in general. To successfully manage chronic daily headache syndromes it's vital to exclude secondary causes with comprehensive history and relevant investigations; determine risk factors that predict its development and recognise its subtypes to befittingly manage the condition. Chronic migraine, chronic tension-type headache, new daily persistent headache and medicine overuse headache accounts for the overwhelming majority of chronic daily headaches. The scope of this text is to review the first headache disorders. Secondary headaches don't seem to be mentioned except medication overuse headache that usually accompanies primary headache disorders. The article critically reviews the literature on this understanding of daily headache disorders focusing specifically on recent developments within the treatment of frequent headaches.

Medical terms

• Most people have headaches from time to time. However, if you have a headache for additional days than not, you may have chronic daily headaches. instead of a selected headache type, chronic daily headaches embrace a spread of headache subtypes. Chronic refers to how usually the headaches occur and the way long the condition lasts. The constant nature of chronic daily headaches makes them one in every of the foremost disabling headache conditions. Aggressive initial treatment and steady, semipermanent management might cut back pain and cause fewer headaches.Chronic Daily Headache (CDH) could be a descriptive term and not a diagnosis per se. It's normally outlined as headaches occurring on fifteen or additional days during a month for a minimum of 3 months and affects around four% of the overall population.The term CDH is especially mentioned as the first headache disorder, though secondary CDH should be excluded. Common secondary causes are given .The primary CDH is split into short and long periods . The short duration i.e. lasting < 4> 4 hours embrace chronic hemicrania (CM), chronic tension-type headaches (CTTH), hemicrania continua (HC) and new daily persistent headaches (NDPH) although CM and CTTH account for the immense majority.Medication overuse headaches (MOH), primarily a secondary headache disorder normally accompany the first headache disorders and are delineate with them. 

The types of chronic daily headaches

There are five types of chronic daily headaches, according to Dr. Soni. They are:

• Chronic migraines.

• Chronic tension headaches.

• Chronic post-traumatic headaches.

• New daily persistent headaches.

• Hemirina contínua.

Symptoms Chronic daily headaches

By definition, chronic daily headaches occur fifteen days or additional a month, for more than 3 months. True (primary) chronic daily headaches aren't caused by another condition. 

There are short-lasting and durable chronic daily headaches. durable headaches last over four hours. They include:

• Chronic migraine

• Chronic tension-type headache

• New daily persistent headache

• Hemicrania continua

Chronic migraine

This type generally happens in folks with a history of episodic migraines. Chronic migraines tend to:

• Affect one side or both sides of your head

• Have a pulsating, throbbing sensation

• Cause moderate to severe pain

And they cause at least one of the following:

• Nausea, vomiting or both

• Sensitivity to light and sound

Chronic tension-type headache

These headaches tend to:

• Affect both sides of your head

• Cause mild to moderate pain

• Cause pain that feels pressing or tightening, but not pulsating

New daily persistent headache

These headaches come back on suddenly, typically in folks while not having a headache history. They become constant during the 3 days of your 1st headache. They:

• Often affect both sides of your head

• Cause pain that feels like pressing or tightening, but not pulsating

• Cause mild to moderate pain

• Might have features of chronic migraine or chronic tension-type headache

Hemicrania continua

These headaches:

• Affect only one side of your head

• Are daily and continuous with no pain-free periods

• Cause moderate pain with spikes of severe pain

• Respond to the prescription pain reliever indomethacin (Indocin)

• Can become severe with development of migraine-like symptoms

In addition, hemicrania continua headaches are associated with at least one of the following:

• Tearing or redness of the eye on the affected side

• Nasal congestion or runny nose

• Drooping eyelid or pupil narrowing

• Sensation of restlessness

When to see a doctor

Suffering from chronic tension headaches may seem like your fate for life. However there are several things you can try to relieve the discomfort of these common and painful headaches. A doctor should be consulted before beginning any self-treatment program since some medications can potentially interact with the other drugs you take.

Occasional headaches are common, and usually require no medical attention. However, consult your doctor if:

• You usually have two or more headaches a week

• You take a pain reliever for your headaches most days

• You need more than the recommended dose of over-the-counter pain remedies to relieve your headaches

• Your headache pattern changes or your headaches worsen

• Your headaches are disabling

Seek prompt medical care if your headache:

• Is sudden and severe

• Accompanies a fever, stiff neck, confusion, seizure, double vision, weakness, numbness or difficulty speaking

• Follows a head injury

• Gets worse despite rest and pain medication

Causes Chronic daily headaches

The causes of the many chronic daily headaches aren't well-understood. True (primary) chronic daily headaches don't have AN diagnosable underlying cause. Conditions that may cause non primary chronic daily headaches include:

• Inflammation or other problems with the blood vessels in and around the brain, including stroke

• Infections, such as meningitis

• Intracranial pressure that's either too high or too low

• Brain tumor

• Traumatic brain injury

Medication overuse headache

This type of headache typically develops in those who have an episodic headache disorder, usually hemicrania or tension type, and take an excessive amount of pain medication. If you're taking pain medications — even over-the-counter — quite 2 days every week (or 9 days a month), you're in danger of developing rebound headaches.

Risk factors Chronic daily headaches

Factors associated with developing frequent headaches include:

• Female sex

• Anxiety

• Depression

• Sleep disturbances

• Obesity

• Snoring

• Overuse of caffeine

• Overuse of headache medication

• Other chronic pain conditions

Complications Chronic Daily Headaches

If you've got chronic daily headaches, you're additionally doubtless to own depression, anxiety, sleep disturbances, and different psychological and physical problems.

Prevention Chronic Daily Headaches

Taking care of yourself might help ease chronic daily headaches.

• Avoid headache triggers. Keeping a headache diary can assist you confirm what triggers your headaches in order that you'll be able to avoid the triggers. embrace details concerning each headache, admire once it started, what you were doing at the time and the way long it lasted. 

• Avoid medication overuse. Taking headache medications, together with over-the-counter medications, quite double every week will increase the severity and frequency of your headaches. Consult your doctor regarding the way to wean yourself off the medication as a result of there are often serious facet effects if done improperly. 

• Get enough sleep. The average adult wants seven to eight hours of sleep a night. It's best to travel to bed and awaken at a similar time each day. visit your doctor if you have got sleep disturbances, resembling snoring. 

• Don't skip meals. Eat healthy meals at identical times daily. Avoid food or drinks, resembling those containing caffeine, that appear to trigger headaches. melt off if you're obese. 

• Exercise regularly. Regular aerobic physical activity will improve your physical and mental well-being and scale back stress. together with your doctor' OK, opt for activities you relish — love walking, swimming or cycling. To avoid injury, begin slowly. 

• Reduce stress. Stress could be a common trigger of chronic headaches. Get organized. alter your schedule. arrange ahead. keep positive. strive for stress-reduction techniques, love yoga, martial art or meditation. 

• Reduce caffeine. While some headache medications embody caffeine as a result of it being useful in reducing headache pain, it also can worsen headaches. try to minimize or eliminate caffeine from your diet. 

Diagnosis Chronic daily headaches

Patients who have chronic daily headaches ought to give a history and have a physical examination with an entire medical specialty examination and medicine review. Unless general symptoms are present, there's no role for laboratory testing. it's necessary to judge for red flags (Table 23,6 ) that will counsel a secondary reason behind headache or a headache requiring additional immediate evaluation. Table three lists a number of the more common secondary causes of headache.3 It's important to stay in mind that the foremost pervasive secondary cause of chronic daily headache, medication overuse, typically coexists with a primary headache syndrome. Once other secondary causes are dominated, the clinical history helps verify what style of primary headache is present.Your doctor can probably examine you for signs of illness, infection or medicine issues associated with your headache history. If the reason behind your headaches remains uncertain, your doctor could possibly order imaging tests, corresponding to a CT scan or MRI, to appear for an underlying medical condition.

Treatment Chronic daily headaches

Treatment for an underlying condition usually stops frequent headaches. If no such condition is found, treatment focuses on preventing pain. hindrance methods vary, looking at the kind of headache you've got and whether or not medication overuse is contributory to your headaches. If you're taking pain relievers quite 3 days a week, the primary step may be to wean yourself off these medications together with your doctor' guidance.

When you're ready to begin preventive therapy, your doctor may recommend:

• Antidepressants. Tricyclic antidepressants — love Pamelor (Pamelor) — will be wont to treat chronic headaches. These medications also can facilitate treatment of the depression, anxiety and sleep disturbances that usually accompany chronic daily headaches. alternative antidepressants, such as the selective monoamine neurotransmitter uptake substance (SSRI) SSRI (Prozac, Sarafem, others), may help in treating depression and anxiety, however haven't been shown to be simpler than placebo for headaches. 

• Beta blockers. These drugs, unremarkably wont to treat high blood pressure, are a mainstay for preventing episodic migraines. These embody Tenormin (Tenormin), Lopressor (Lopressor, Toprol-XL) and propranolol (Inderal, Innopran XL). 

• Anti-seizure medications. Some anti-seizure medicine appears to stop migraines and may be accustomed to prevent chronic daily headaches, as well. choices embrace topiramate (Topamax, Qudexy XR, others), divalproex metal (Depakote) and gabapentin (Neurontin, Gralise). 

• NSAIDs. Prescription nonsteroidal anti-inflammatory drug medication — equivalent to Aleve (Anaprox, Naprelan) — may well be helpful, particularly if you're retreating from different pain relievers. they'll even be used sporadically once the headache is additional severe. 

• Botulinum toxin. OnabotulinumtoxinA (Botox) injections give relief for a few individuals and can be a viable possibility for those who don't tolerate daily medication well. botulinum toxin would presumably be thought-about if the headaches have options of chronic migraines. the utilization of 1 drug is preferred, however if one drug doesn't work well enough, your doctor may contemplate combining drugs. 

Alternative medicine

For many people, complementary or various therapies provide relief from headache pain. It's vital to be cautious, however. Not all complementary or alternative therapies are studied as headache treatments, et al. would like additional research.

• Acupuncture. This ancient technique uses hair-thin needles inserted into many areas of your skin at outlined points. whereas the results are mixed, some studies have shown that stylostixis helps scale back the frequency and intensity of chronic headaches. 

• Biofeedback. You might be able to manage headaches by changing into a lot of awake to then dynamical bound bodily responses, appreciating muscle tension, pulse and skin temperature. 

• Massage. Massage will cut back stress, relieve pain and promote relaxation. Though its price as a headache treatment hasn't been determined, massage can be notably useful if you've got tight muscles within the back of your head, neck and shoulders. 

• Herbs, vitamins and minerals. Some proof exists that the herbs herb and Petasites vulgaris facilitate stop migraines or scale back their severity. A high dose of nutriment B-2 (riboflavin) conjointly may reduce migraines. molecule Q10 supplements could be useful in some individuals. And oral sulfate supplements might reduce the frequency of headaches in some people, though studies don't all agree. raise your doctor if these treatments are right for you. Don't use riboflavin, feverfew or butterbur if you're pregnant. 

• Electrical stimulation of the occipital nerve. A small powered conductor is surgically established  close to the bone nerve at the bottom of your neck. The electrode sends continuous energy pulses to the nerve to ease pain. This approach is taken into account investigational. Before attempting complementary or different therapy, discuss the risks and advantages along with your doctor. 

Coping and support

Chronic daily headaches will interfere along with your job, your relationships and your quality of life. Here are suggestions to assist you upset the challenges.

• Take control. Commit yourself to living a full, satisfying life. Work along with your doctor to develop a treatment set up that works for you. Take excellent care of yourself. Do things that elevate your spirits. 

• Seek understanding. Don't expect friends and pet ones to instinctively recognize what's best for you. raise what you need, whether or not it's time alone or less attention paid to your headaches. 

• Check out support groups. You might find it useful to talk to other people who have painful headaches.

• Consider counseling. A counselor or expert offers support and may assist you manage stress. Your therapist also can help you perceive the psychological effects of your headache pain. In addition, there' proof that psychological features in behavioral medical care can cut back headache frequency and severity. 

Preparing for your appointment

You're probably to begin by seeing your GP or a general practitioner. However, you will be noticed by a headache specialist. Here's some data to assist you make preparations for your appointment.

What you can do

Be aware of pre-appointment restrictions. When you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet.

• Keep a headache journal, including when each headache occurred, how long it lasted, how intense it was, what you were doing immediately before the headache started, and anything else notable about the headache.

• Write down your symptoms and when they began.

• Write down key personal information, including major stresses or recent life changes and family history of headaches.

• List all medications, vitamins or supplements you're taking, including doses and frequency of use. Include medications used previously.

• Write down questions to ask your doctor.

Take a family member or friend along, if possible, to help you remember information.

For chronic headaches, some questions to ask your doctor include:

• What's the likely cause of my headaches?

• What are other possible causes?

• What tests do I need?

• Is my condition likely temporary or chronic?

• What's the best course of action?

• I have other health conditions. How can I best manage them together?

• Should I see a specialist?

• Are there printed materials I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you questions, such as:

• Have your headaches been continuous or occasional?

• How severe are your headaches?

• What, if anything, seems to improve your headaches?

• What, if anything, appears to worsen your headaches?

What you can do in the meantime

To ease your headache pain until you see your doctor, you might:

• Avoid activities that worsen your headaches.

• Try over-the-counter pain relief medications — such as naproxen sodium (Aleve) and ibuprofen (Advil, Motrin IB, others). To avoid rebound headaches, don't take these more than three times a week.

General summary

1. Suffering from chronic tension headaches may seem like your fate for life. However there are several things you can try to relieve the discomfort of these common and painful headaches. A doctor should be consulted before beginning any self-treatment program since some medications can potentially interact with the other drugs you take.

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