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When the pain won’t go away: Managing chronic headaches

The occasional headache can be a pain and nuisance. The good news is they typically come and go with little or no treatment. But for many, headaches can be a source of continual and sometimes debilitating pain that can last for days, weeks or longer.

Chronic headaches occur 15 days or more per month over a 3-month period. They can happen at any age and can be severe enough to interfere with daily activities.  It’s no wonder that the frequent pain and other symptoms that come with chronic headaches can often lead to depression, anxiety, sleep problems and other physical and mental health issues.

What are the types of chronic headaches?

There are multiple types of headaches that can be become long-lasting. The most common types of chronic headaches include:

  • Tension headaches. Normal tension headaches are common among teens and adults and come and go over time. But when headache days outnumber headache-free days, they become chronic. Tension headaches can affect both sides of the head and are marked by dull pain, tightness or pressure around the forehead, back of head or neck. Tension headaches can last 30 minutes to several hours.

  • Migraines. Migraine attacks are less common, but more severe than tension headaches. Intense throbbing pain may occur on one or both sides of the head. Accompanying symptoms may include nausea or vomiting; sensitivity to light, sound or smells; or visual disturbances called auras. In the U.S, nearly 40 million Americans suffer from migraines, including 28 million women and girls, according to the World Health Organization. Migraines can last 4 to 72 hours.

  • Cluster headaches. These sudden headaches are typically marked by pain on one side of the head behind the eye. They can last for weeks or several months and sometimes occur multiple times a day. Cluster episodes are usually followed by a period of remission that can last several months or years. Men are more likely than women to have cluster headaches, which can also cause restlessness and watery eyes. Medication is often prescribed as treatment.

  • New daily persistent headaches. While these sudden headaches can mimic migraines or chronic tension-type headaches, new daily persistent headaches occur in people who do not have a history of headaches. Testing may be required to determine if the onset of frequent headaches is caused by an underlying condition.

  • Hemicrania continua. This rare but treatable headache disorder causes continuous pain on one side of the face and head for at least three months. Additional symptoms include red and eyes, drooping eyelid, sweating, runny nose and nasal congestion. Some sufferers of this disorder also experience restlessness and migraine-like symptoms, such as light sensitivity and stabbing pain.

What causes chronic headaches?

The cause of chronic headaches can be a head-scratcher. It’s estimated that only 10 percent of headaches have a known underlying cause.

There are, however, certain risk factors that may trigger persistent headaches, including:

  • Fluctuating hormonal changes, especially when estrogen falls around the time a woman has her period
  • Genetics
  • High levels of stress
  • Lack of sleep/sleep disturbance
  • Anxiety and depression
  • Too much caffeine and alcohol
  • Skipped meals
  • Weather changes
  • Certain foods

Another cause of chronic headaches is overuse of pain medication. While prescription and over-the-counter pain medication can relieve discomfort, long-term use can make things worse for headache sufferers. Medication overuse headaches, or rebound headaches, can occur when pain medication is taken for more than three days a week, according to the National Institute of Neurological Disorders and Stroke.

Is a persistent headache a symptom of long COVID?

Headaches are one of the most common symptoms among COVID-19 “long-haulers,” or those with lingering issues related to the virus. New persistent daily headaches are being seen more and more in people who contract COVID-19. Individuals who already deal with regular migraines and other headache disorders also report increased frequency of headaches after a COVID diagnosis, even when they have a relatively minor case of the virus.

What’s the best defense against a lingering COVID-19 headache? Get vaccinated. Medical experts agree that it’s the best way to avoid the coronavirus and the chance of serious illness, hospitalization and long-haul symptoms, including headaches.

How can I prevent chronic headaches?

Chronic daily headaches can stop you in your tracks, but there are some healthy steps you can take to ease their frequency:

  • Identify (and avoid) triggers. Keep a headache diary to help determine what causes your headaches so that you can avoid the triggers. Track the onset of each headache, what you were doing at the time and how long it lasted. 

  • Ease up on the pain meds. Talk with an Indigo primary care provider about how much pain medication you’re taking and how to wean yourself if medication is worsening your symptoms.

  • Make sleep a priority.The average adult needs seven to nine hours of sleep a night. A consistent sleep schedule is the ticket to a better night’s sleep, so try to go to bed and wake up at the same time every day. Talk to your doctor if you have sleep disturbances, such as snoring.

  • Switch up your diet.Establish regular mealtimes or eating patterns and stick to them. Opt for more anti-inflammatory foods like fatty fish, whole grains and dark, leafy greens. Eliminate potential triggers, such as highly processed foods, chocolate, aged cheeses, processed meats high in nitrates, high-sugar foods and gluten.

  • Exercise regularly.It’s not just great for your body. Regular physical activity can improve your mental well-being, reduce stress and ease muscle tension that can trigger headaches. Aim for 30 minutes of moderate exercise at least five days a week. Start slowly to avoid injury.
  • Tamp down the stress.Life is stressful, especially when you’re balancing work, kids and…well, everything else. Try stress-reduction techniques, such as meditation, deep breathing, yoga or tai chi. Even a simple “me” time-out, like a walk and getting some fresh air, can make a difference.

  • Cut back on the caffeine.It’s true that some headache medications include caffeine, and a small about can help reduce headache pain. But too much of the stuff can raise blood pressure and trigger a headache. Soda pop and energy drinks are the worst offenders.

  • Limit alcohol. To reduce headaches and other alcohol-related health issues, the Centers for Disease Control and Prevention (CDC) recommends limiting your intake to one drink a day for women or two drinks a day for men.

When should I see a doctor about my headaches?

While occasional head pain is normal, you should talk with a medical provider if:

  • Your headaches occur more than twice a week.
  • You take pain relievers daily or most days for headache pain.
  • Your headaches affect your quality of life and ability to perform daily activities.
  • Headaches happen more often or worsen over time.

How can Indigo help my chronic headaches?

If you have chronic headaches, you don’t need to live with the pain. And you don’t need to wait for relief. Refreshingly friendly, convenient Indigo Online Care is as close as your phone or favorite device.

With our quick and easy online scheduling and check-in, you can chat directly with one of our Indigo primary care providers when and where it works best for you. Video visits are available 8 am to 8 pm, every day.

During your appointment, a provider will evaluate your symptoms to understand what type of headaches you are having and what may be triggering them. Together, you’ll create a treatment plan focused on pain management and prevention that’s most effective for you. They will also prescribe medication, if needed, and schedule a follow-up appointment to see how you’re doing.

And if you need a higher level of care to get to the root of your chronic headaches, an Indigo provider will coordinate a referral to a headache specialist.

When is a headache an emergency?

Sometimes a headache could be a symptom of something more serious. If you have any of the following symptoms, it’s a good idea to head to your nearest ER for immediate care:

  • A severe headache that comes on suddenly
  • Neurological symptoms, such as confusion, numbness, or difficulty with coordination, walking or speaking
  • Vision loss or unconsciousness
  • High fever, stiff neck, nausea or vomiting
  • A headache that follows a head injury
  • Headache pain that lasts more than 72 hours with less than 4 hours without pain

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