One of the most common medical conditions that people experience is headaches. Between 50% and 75% of people ages 18 to 65 report having had at least one headache in the past year, with 1.7%–4% having chronic cases, defined as having 15 or more attacks a month. Frequent or continuous headache disorders affect not only work and social life but they also can have a devastating impact on mental health.
Continuous headaches may arise as the symptoms of other health issues, such as inflammation of blood vessels or infection in the brain. When a headache stems from another disorder, it is referred to as secondary headache. Primary headaches are neurologocial disorders that do not accompany other disorders and include chronic migraines, cluster headaches, or new daily persistent headaches (NDPH).
While management of continuous or chronic headache problems is rarely straightforward, medical approaches, lifestyle changes, and other means can help. This article covers the basics of continuous headaches, including what causes them, what treatment is like, as well as what you can do to prevent their onset.
Causes of Continuous Headaches
While the exact mechanisms of continuous headaches are unknown, neuroimaging studies have linked them to hyperexcitability in certain nerve cells in the brain stem and cortex. Specifically, continuous headaches may be caused by excessive sensitivity of the trigeminal nerve, the part of the nervous system associated with pain, touch, and temperature sensations in the face and head.
Notably, other health conditions, such as injury, infections, or underlying health status, can also cause chronic head pain, although this is much rarer. Among the many secondary headache causes are encephalitis (swelling in the brain), meningitis (infection of the tissues around the brain), and viral infections.
In some cases, acute headache problems progress into chronic ones. Several factors increase this risk, including:
- Stress: A common factor in many kinds of headaches, stress can also spur continuous or chronic headaches.
- Sleep disturbances: Sleep problems, such as insomnia and sleep apnea are linked to chronic headache conditions. In addition, if you don’t get enough sleep (at least seven to eight hours a night), or if you don’t have a consistent sleep schedule, you may be prone to chronic problems.
- Obesity: Excessive weight, especially obesity—defined as a body mass index (BMI) of 30 or above—is also linked with headache problems. While the exact relationship between chronic headaches and obesity is unknown, there may be higher levels of inflammation in individuals who fall into the obese range, who secrete more hormones associated with pain.
- Caffeine: As found in coffee, certain teas, and in some over-the-counter (OTC) pain medications, caffeine is a stimulant that profoundly affects brain function. Overuse raises the risk of developing continuous headaches. For some, however, it can help relieve headaches, and regular caffeine users may develop headaches when they stop getting caffeine.
- Medication overuse: Taking too many OTC or prescribed medications for pain can actually make your headaches worse and more frequent. This is known as medication overuse headaches (MOH). Problematic classes of drugs include analgesics, triptans, ergotamine, and opioids, among others. These headaches usually stop when you stop taking your medication.
While they can be very distressing and have a terrible burden, continuous headaches are only rarely a sign of a dangerous condition.
As noted, continuous headaches can be either the symptoms of other conditions (secondary headaches) or a specific neurological condition (primary headaches). And while most people don’t experience continuous headaches, many types of headache can worsen and become chronic.
The most common type of headache is tension headache. Tension headaches feel like a growing pressure and tightening. The pain is generally mild to moderate and can affect both sides of the head. Unlike other headache types, it doesn’t worsen with physical activity. Chronic tension headaches affect about 4% of the population, and, like migraines, they’re more prevalent in women.
Migraine is very common, affecting about 1 in 6 Americans, with women more often affected than men. Migraine attacks can last anywhere from four to 72 hours or more and recur (to be diagnosed, you have to have had at least five attacks). People who experience migraines 15 or more times a month—including those who have them less frequently but still persistently—have chronic migraine.
The symptoms of migraines vary a great deal from person to person. However, the typical signs include:
- Stabbing or pulsating moderate to severe headache, often on one side of the head
- Nausea and vomiting
- Sensitivity to light and sound
- Auras (visual disturbances like zigzags or flashes)
Migraines may result from the following common triggers:
- Stress and anxiety
- Lack of sleep
- Bright or flashing lights
- Hormonal changes (as in menstruation or menopause)
- Certain foods and drinks
- Physical overexertion
- Changes in weather
When the continuous headaches are migraines, they’re sometimes called “transformed migraines.” In many cases, this is a kind of medication overuse headache (MOH) caused by using too many abortive pain medications, such as Tylenol (acetaminophen), nonsteroidal anti-inflammatory drugs (NSAIDs, like ibuprofen and naproxen sodium), triptans, ergotamine, and others.
A particularly debilitating primary headache disorder, hemicrania continua is characterized by continuous moderate pain on one side of the head and face. This may be punctuated with periods of more intense headaches. Unlike migraines, this type doesn’t have triggers. Along with headache it also causes:
- Pain in the eye
- Nasal congestion, runny nose
- Drooping eyelid (ptosis)
- Redness in the eye, tearing
Additionally, hemicrania continua can bring on migraine-like symptoms, like nausea and sensitivity to light or sound.
New Daily Persistent Headache
New daily persistent headache (NDPH) is a very rare, very debilitating primary headache disorder. Its symptoms are similar to those of migraine and tension headaches. These headaches occur daily and often are continuous, with symptoms including:
- Sharp, stabbing headache, usually on one side of the head
- Nausea and vomiting
- Flu symptoms during initial onset
- Light and sound sensitivity
- Symptoms worsening with physical activity
Continuous headaches may also be caused by injury, infections, or other health conditions. Generally, resolving the underlying issue will manage the case. Causes of chronic secondary headaches are many and include:
Chronic and continuous headaches are difficult to manage and your treatment depends on the underlying causes. Therapy involves finding the specific combination of medications, lifestyle changes, and other methods that works for you.
Continuous headaches are notoriously difficult to manage. Standard drug therapies for headaches and migraines after they’ve set on include:
- Analgesics: OTC painkillers like Advil (ibuprofen) or Aleve (naproxen) and prescription pain medications may be recommended. However, their use is carefully monitored due to the risk of MOH.
- Triptans: Often prescribed to help with migraines, triptans include Imitrex (sumatriptan) and Zomig (zolmitriptan).
- Ergot alkaloids: Ergot derivatives, such as dihydroergotamine and ergotamine, can also help. These are also available as nasal sprays or injections for faster activity.
Avoiding Rebound Headaches
In many cases, the kinds of medicines that work for acute attacks, such as NSAIDs and triptans, can also cause MOH. Stopping these could actually resolve the headache problem. Talk to your healthcare provider before making any changes.
Medications aimed at preventing the onset of headache attacks are often at the heart of therapy for continuous headache. A number of classes of drugs may help, including:
- Tricyclic antidepressants: Drugs like amitriptyline and nortriptyline can be prescribed as a means of preventing migraines and helping in chronic cases. They’re often indicated for anxiety and depression, which often are present alongside continuous headache cases.
- Anticonvulsants: Anti-seizure medications may also help prevent attacks. These include Topamax (topiramate) and Neurontin (gabapentin).
- Monoclonal antibodies: A newly approved class of drug, calcitonin gene-related peptide (CGRP) monoclonal antibodies, such as Aimovig (erenumab) and Vyepti (eptinezumab), are also prescribed for chronic headaches.
- Beta-blockers: Usually used to treat heart arrhythmia (irregular heart rate or pattern), beta-blockers like Inderol (propranolol) and Lopresor (metoprolol) can also be used to prevent headache onset.
- Botox injection: Injecting onabotulinumtoxinA, or Botox, into nerves associated with pain can also be attempted in difficult cases. This essentially knocks these nerves out, providing pain relief; however, the effect only lasts about three months, and multiple therapies are needed.
Therapy and Counseling
There’s no doubt that continuous headaches can have a significant impact on mental health. Research suggests that chronic headache conditions, depression, and anxiety are closely related and often occur at the same time.
Specific therapy for these mental health conditions is often a necessary part of chronic headache treatment. In addition, behavioral techniques can help ease stress and tension, which are often linked with headaches.
For chronic headache—and along with medications and other treatments—your healthcare provider may recommend several such strategies, such as:
- Cognitive behavioral therapy: A form of talk therapy, cognitive behavioral therapy (CBT) is aimed at fostering strategies for changing negative thoughts to cope with pain.
- Biofeedback: In this therapy, you wear devices to track your body’s signs of rising stress and tension. Biofeedback also lets you develop relaxation techniques to ease these, allowing you to proactively manage headaches.
- Relaxation: Working on meditation, relaxation, and mindfulness techniques can also help with chronic and continuous pain. It can also help you manage stress, which can inflame a headache problem.
Managing continuous headaches also means working to prevent them from flaring up and getting worse. Especially when paired with other treatments, lifestyle changes and taking up certain at-home strategies can help you prevent the onset of attacks as well as manage your condition. Here’s what you should keep in mind:
- Exercise: Regular and consistent exercise—at minimum 30 minutes of light to moderate activity a day—improves sleep and helps ease the burden of chronic headaches.
- Eat well and regularly: Missing meals can also make headaches worse and bring them on. Try to eat at the same times every day, avoid snacking, and, of course, aim for healthy choices.
- Sleep well: Not getting enough sleep or changes in your regular sleep pattern can also lead to headaches. Make sure you go to bed and wake up at the same times every day, and, if you’re an adult, make sure you’re getting seven to eight hours a night.
- Manage stress: Figuring out ways to cope with stress in healthy ways can go a long way in preventing or easing headaches. Try yoga, meditation, or other activities, such as gardening or taking a bath.
- Avoid triggers: Migraine sufferers should keep track of the foods, drinks, and circumstances that lead to or worsen attacks. With a log of your triggers, you’ll be better able to avoid them.
Some complementary therapies may also help with continuous headaches, including:
Medical Procedures and Devices
When medications and other methods aren’t yielding results, neurologists and pain specialists may consider neurostimulation to help with pain. With this therapy, mild electrical shocks or magnetic waves are directed to nerves associated with pain. This overstimulates these regions, stopping the brain from receiving headache sensations.
Several neurostimulation therapies, some of which are available without a prescription, are:
- Trigeminal nerve stimulation (e-TNS): A device, such as the Cefaly, is worn on the forehead directs electrical signals to the trigeminal nerve, which is associated with headache pain. These are controlled by the user, with settings both for attacks and for prevention.
- Single-pulse transcranial magnetic stimulation (s-TMS): Specialized devices, such as the eNeura, stimulate nerves associated with pain using magnetic fields. This type is held to the back of the head and can work both to ease symptoms and help with prevention. It is only available with a prescription.
- Vagus nerve stimulation: Electrical stimulation of the vagus nerve in the neck can also help with chronic headache problems. This type may be attempted in difficult cases of migraine and cluster headaches.
- Occipital nerve stimulation (ONS): The occipital nerve in the temples can also be implicated in chronic headaches. ONS devices, like others, direct electricity to this nerve using electrodes through the skin or via a remote-controlled implant.
When to Seek Medical Attention
Ultimately, if you’re finding your headaches disrupting your life, it’s worth considering treatment. However, most headache problems aren’t signs of dangerous other conditions. That said, there are several cases that warrant immediate medical attention:
- Headache like a “thunderclap”—very severe and with rapid onset
- Headache that worsens significantly when you change the position of your head
- Headaches that start when coughing, sneezing, or due to physical exertion
- Changes in your regular headache pattern; sudden onset of new headaches over age 50
- Weakness or numbness on one side of the body; difficulty walking, talking
- Loss of consciousness
- Worsening headache
- Fever, chills, night sweats, or rapid weight loss
- Memory problems, difficulty speaking or understanding
Continuous headaches, which can occur in the form of tension headaches, migraines, hemicrania continua, new daily persistent headaches, and various secondary headaches, can be caused by many factors, and perhaps even multiple factors at a time. Risk factors include stress, inadequate sleep, obesity, caffeine, and medication overuse.
Treatments for continuous headaches also vary greatly depending on the cause. Methods range from medications to lifestyle changes to medical devices and even psychotherapy. A healthcare provider can help determine what the best method or methods are for you.
A Word From Verywell
There’s no denying that continuous, persistent headaches can leave a terrible burden. However, it’s important not to give up on finding a treatment.
As we learn more about what causes these headaches—and as researchers develop newer medications and therapies—it’s important to remember how far the medical community has come. In absence of a silver bullet, know that there are many ways to manage and treat continuous headaches, and there are more on the way. The most important step is the first one: seeking out the help you need.
Frequently Asked Questions
When should you worry about a headache?
While most headaches aren’t a sign of serious problems, you should call your healthcare provider and consider it an emergency when:
- The headache is more severe than ever before.
- There is very rapid onset of headache.
- Your head pain gets worse with head movement.
- Pain is felt from physical exertion, coughing, and sneezing.
- You’ve lost consciousness.
- The headache is worsening.
- Your headaches have a different pattern than usual.
In addition, get help if your headaches are accompanied by:
- Memory problems
- Difficulty speaking or understanding
- Fever and/or chills
- Rapid weight loss
Why do I wake up with a headache every morning?
There are many reasons you experience headaches upon waking up. It can result from chronic migraines or other chronic headache disorders, disruptions in your sleep-wake cycle (circadian rhythm), sleep apnea, and teeth grinding.
Why is my headache worse when I lie down?
Headaches that get worse when you lie down can be a sign of a serious problem, and you should get emergency help if you experience them. Potential causes include:
- Idiopathic intracranial hypertension (high spinal fluid pressure)
- Cerebrospinal fluid leak
- Sinus infection
- Brain tumors