Chronic Headache

Chronic Headaches are defined as daily, or almost daily, for at least 3-4 weeks, sometimes years. The longer it’s been going on, the less worried we are that it might be dangerous. But we can’t forget that a new headache may develop along with the usual one; and the new one could be anything.

In terms of the Chronic Headache, clinicians approach the symptom by considering all possibilities:

Causes of Chronic Headaches

zzzzzzzzzzDangerouszzzzzzNot Dangerous (Usually)
** Tumors / Blood Clots / Hydrocephalus
xxx—  (increased intracranial pressure) *
** Temporal Arteritis *
** Idiopathic Intracranial Hypertension (I.I.H.)
** Depression AND Suicidal


*  unlikely to last much more than 1-2 months (without something terrible happening)
zz
zz

xx
** Tension Headache
** Chronic Cluster Headache
** Chronic Migraine
** Allergic Rhinitis
(hay fever) / Sinusitis
** Neck Sprain or Strain
** Medication Overuse Headache
** Medications / Drugs / Toxins / Irritants
** Irritating Symptom Elsewhere in Body

** Stress
** Special Headaches
** Depression

1.  Consider Chronic Headaches which are Dangerous

** Increased Intracranial Pressure (in the brain) from tumors, etc. Needs CT Scan of brain if any of the following (but otherwise, not):

  • progressively getting worse week by week
  • nausea / vomiting; pain worse with straining
  • personality changes
  • any abnormality on neurological examination
  • Older patients at more risk, require a CT scan, especially if recent trauma

** Temporal Arteritis — Patients over age 50 with new headache need blood test “Sed Rate;” the disease can cause sudden blindness

** Idiopathic Intracranial Hypertension (I.I.H.): the only dangerous physical disease which can cause a headache lasting many months (can permanently damage vision)

  • Most commonly affects obese women 30-50 years old
  • Most patients have some sort of visual symptoms
  • Might be suspected by eye exam; diagnosis by spinal tap

** Suicide — A depressed person may seek care for a headache. Whenever we diagnose depression, we always ask, “Is your depression so strong that you sometimes think of killing yourself?

  • If so, we ask simply if they have a plan, have the means, and evaluate risk from there
  • See also Depression

2. Address More Common Causes:

**  Nasal Congestion / Sneezing  —  Treatment trial of allergy medication, for Allergic Rhinitis

**  Pain with head & neck movement  —  Treat for Neck Sprain / Strain

**  Migraine Symptoms:

  • Pulsating headache / one side / nausea or no appetite / light & noise is irritating
  • Treatment trial of prevention medicine for Migraine

**  Taking pain medicines practically daily  —  Medication Overuse Headache

  • Stop the pain medicines.  Treatment trial of anti-migraine prevention medicine (see Migraine)

** History of Concussion (after which headache began) — may be Post-Concussive Syndrome

**  Using Drugs / exposed to Toxins  —  Stop using / Avoid exposure

** Ongoing Stress — Only blame it on this if that’s when the headache began

**  Chronic Cluster Headaches

  • Bursts of short-lasting headaches, many times a day.  Usually one-sided (behind the eye);
  • Maybe same-sided symptoms like droopy eyelid, tearing, tiny pupil, runny nose, sweating on forehead (just one side)
  • Needs referral to headache specialist (neurologist)

**  Depression as cause of headache:

  • sadness, no energy, no joys, urge to cry, feeling useless, poor concentration, frequent thoughts of death (suicidal thoughts or intent requires urgent intervention)
  • Treatment trial (medication / therapy)

**  Chronic Tension Headache  —  Most likely & common cause of chronic headaches

  • Both sides, pressure or squeezing, always stays the same
  • No danger signs as in #1 above
  • Best treatments are special ones for chronic pain, not common pain medications

See also Chronic Headaches — Full Text for more in-depth explanations and discussion.

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