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
| zzzzzzzzzzDangerous | zzzzzzNot Dangerous (Usually) |
|---|---|
| โข Tumors / Blood Clots / Hydrocephalus xxx—ย (increased intracranial pressure) ** โข Temporal Arteritis * โข Idiopathic Intracranial Hypertension (I.I.H.) โข Depression AND Suicidal **ย unlikely to last much more than 1-2 months (without something terrible happening)zz zz xx | โข Tension Headache โข Chronic Cluster Headache โข Chronic Migraine โข Allergic Rhinitis (hay fever) / Sinusitis โข Neck Sprain or Strain โข Medication Overuse Headache โข Medications / Drugs / Toxins / Irritants โข Irritating Symptom Elsewhere in Body โข Stress โข Special Headaches โข 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. See disease link for further diagnostics if Sed Rate is high.
** 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
- 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.