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Symptoms

By Mayo Clinic staff

By definition, chronic daily headaches must occur 15 days or more a month, for at least three months. And to be considered true (primary) chronic daily headaches, they must also not be the result of another condition.

Chronic daily headaches are classified by how long they last — more than four hours or less than four hours. The longer lasting headaches are more common and addressed here. They're divided into four types:

  • Chronic migraine
  • Chronic tension-type headache
  • New daily persistent headache
  • Hemicrania continua

Chronic migraine
These headaches evolve from episodic migraine without aura. To be diagnosed with chronic migraine, you must have headaches — migraine, tension-type or both — 15 days or more a month, for at least three months. In addition, on eight or more days a month for at least three months, you must experience the following symptoms.

Your headaches have at least two of the following characteristics:

  • Affect only one side of your head
  • Cause a pulsating pain
  • Cause moderate to severe pain
  • Are aggravated by routine physical activity

And they cause at least one of the following:

  • Nausea, vomiting or both
  • Sensitivity to light and sound

Alternatively, if your headaches respond to triptan medications or ergot medications taken in anticipation of these symptoms — on eight or more days a month for at least three months — they're also considered chronic migraines.

Chronic tension-type headache
These headaches evolve from episodic tension-type headaches. They may last hours or be constant.

Chronic tension-type headaches have at least two of the following characteristics:

  • Hurt on both sides of your head
  • Cause mild to moderate pain
  • Cause pain that feels pressing or tightening, but not pulsating
  • Aren't aggravated by routine physical activity

In addition, they cause no more than one of the following:

  • Sensitivity to light or sound
  • Nausea (mild only)

New daily persistent headache
These headaches become constant within a few days of the moment you have your first headache.

New daily persistent headaches have at least two of the following characteristics:

  • Hurt on both sides of your head
  • Cause pain that feels like pressing or tightening, but not pulsating
  • Cause mild to moderate pain
  • Aren't aggravated by routine physical activity

In addition, they cause no more than one of the following:

  • Sensitivity to light or sound
  • Nausea (mild only)

Hemicrania continua
These headaches cause pain on only one side of your head that doesn't shift sides. They also:

  • Are daily and continuous with no pain-free periods
  • Cause moderate pain but with spikes of severe pain
  • Respond to the prescription pain reliever indomethacin (Indocin)
  • May sometimes become severe with development of migraine- like symptoms

In addition, hemicrania continua headaches cause at least one of the following:

  • Tearing or redness of the eye on the affected side
  • Nasal congestion or runny nose
  • Drooping of the eyelid or constriction of the pupil

When to see a doctor
Occasional headaches are common. But it's important to take headaches seriously. Consult your doctor if:

  • You usually have two or more headaches a week
  • You take a pain reliever for your headaches every day or almost every day
  • You need more than the recommended dose of over-the-counter pain remedies to relieve your headaches
  • Your headache pattern changes
  • Your headaches are getting worse

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 Definition
References
  1. Rains J, et al. Chronic daily headache: An overview. American Headache Society. http://www.achenet.org/education/patients/chronicdailyheadacheanoverview.asp?print=y. Accessed Nov. 17, 2009.
  2. Headache: Hope through research. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/headache/detail_headache.htm. Accessed Nov. 10, 2009.
  3. Goadsby PJ, et al. Headache. In: Fauci AS, et al. Harrison's Online. 17th ed. Columbus, Ohio: The McGraw-Hill Companies, Inc. 2008. http://www.accessmedicine.com/content.aspx?aid=2890365. Accessed Dec. 23, 2009.
  4. Headache and other craniofacial pains. In: Ropper AH, et al. Adams & Victor's Principles of Neurology. 9th ed. Columbus, Ohio: The McGraw-Hill Companies, Inc. 2009. http://www.accessmedicine.com/content.aspx?aid=3630946. Accessed Dec. 23, 2009.
  5. Boes CJ, et al. In: Bradley WG, et al. Neurology in Clinical Practice. 5th ed. Philadelphia, Pa.: Elsevier; 2008:2053.
  6. Garza I, et al. Overview of chronic daily headache. http://www.uptodate.com/home/index.html. Accessed Jan. 14, 2010.
  7. Olesen J, et al. The international classification of headache disorders. International Headache Society. http://216.25.88.43/upload/CT_Clas/ICHD-IIR1final.pdf. Accessed Nov. 2, 2009.
  8. Sun Y, et al. Acupuncture for the management of chronic headache: A systematic review. Anesthesia & Analgesia. 2008;107:2038.
  9. Calandre EP, et al. Myofascial trigger points in cluster headache patients: A case series. Head & Face Medicine. 2008:4:32.
  10. Ducic I, et al. Indications and outcomes for surgical treatment of patients with chronic migraine headaches caused by occipital neuralgia. Plastic and Reconstructive Surgery. 2009;123:1453.
  11. Pain: Hope through research. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/chronic_pain/detail_chronic_pain.htm. Accessed Nov. 13, 2009.
  12. Vernon H, et al. A randomized, placebo-controlled clinical trial of chiropractic and medical prophylactic treatment of adults with tension-type headache: Results from a stopped trial. Journal of Manipulative and Physiological Therapeutics. 2009;32:344.
  13. Trigger avoidance information. American Headache Society. https://www.americanheadachesociety.org/professionalresources/TriggerAvoidanceInformation.asp. Accessed Nov. 17, 2009.
  14. Rios J, et al. Evidence-based use of botanicals, minerals, and vitamins in the prophylactic treatment of migraines. Journal of the American Academy of Nurse Practitioners. 2004;16:251.
  15. Bajwa ZH, et al. Preventative treatment of migraine in adults. http://www.uptodate.com/home/index.html. Accessed Nov. 17, 2009.
  16. Feverfew. Natural Medicines Comprehensive Database. http://www.naturaldatabase.com. Accessed Nov. 13, 2009.
  17. Butterbur. Natural Medicines Comprehensive Database. http://www.naturaldatabase.com. Accessed Nov. 13, 2009.
  18. Coenzyme Q. Natural Medicines Comprehensive Database. http://www.naturaldatabase.com. Accessed Nov. 13, 2009.
  19. Acupuncture: An introduction. National Center for Complementary and Alternative Medicine. http://nccam.nih.gov/health/acupuncture/introduction.htm. Accessed Nov. 13, 2009.
  20. Meditation: An introduction. National Center for Complementary and Alternative Medicine. http://nccam.nih.gov/health/meditation/overview.htm. Accessed Nov. 13, 2009.
  21. Massage therapy: An introduction. National Center for Complementary and Alternative Medicine. http://nccam.nih.gov/health/massage/. Accessed Nov. 13, 2009.
  22. Prakash S, et al. Hemicrania continua responsive to intravenous methyl prednisolone. Headache. 2009;49:604.
  23. Sullivan MD, et al. Antidepressant and anticonvulsant medication for chronic pain. Physical Medicine and Rehabilitation Clinics of North America. 2006;17:381.
  24. Physical activity fundamental to preventing disease. U.S. Department of Health and Human Services. http://aspe.hhs.gov/health/reports/physicalactivity/. Accessed Nov. 19, 2009.
  25. Headache information page. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/headache/headache.htm. Accessed Nov. 19, 2009.
  26. What do to in a medical emergency: Headache. American College of Emergency Physicians Foundation. http://www.emergencycareforyou.org/EmergencyManual/WhatToDoInMedicalEmergency/Default.aspx?id=248. Accessed Nov. 19, 2009.
  27. Saper JR. Chronic daily headache: Transformational migraine, chronic migraine, and related disorders. Current Neurology and Neuroscience Reports. 2008;8:100.
  28. Swanson JW (expert opinion). Mayo Clinic, Rochester, Minn. Dec. 8, 2009.
  29. Headache Classification Subcommittee of the International Headache Society. The international classification of headache disorders: 2nd edition. Cephalalgia. 2004;24(suppl):9.
  30. Bajwa ZH, et al. Headache syndromes other than migraine. http://www.uptodate.com/home/index.html. Accessed Dec. 8, 2009.
  31. Olesan J, et al. New appendix criteria open for a broader concept of chronic migraine. Cephalalgia. 2006;26:742.
  32. Silberstein SD, et al. The international classification of headache disorders, 2nd edition (ICHD-II) — Revision of criteria for 8.2 Medication — Overuse headache. Cephalalgia. 2005;25:460.
  33. Olesen J, et al. New appendix criteria open for a broader concept of chronic migraine. Cephalalgia. 2006;26:742.

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Jan. 23, 2010

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