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Treatments and drugs
By Mayo Clinic staffTreatment for any underlying diseases or conditions often stops chronic daily headaches. When no underlying diseases or conditions are present, treatment focuses on preventing the pain before it starts.
Specific prevention strategies vary, depending on which type of headache you have and on whether medication overuse is contributing to these headaches. If you're taking pain relievers more than two days a week, the first step in treatment may be to stop using these drugs. When you're ready to begin preventive therapy, your doctor may recommend:
- Antidepressants. Tricyclic antidepressants — including amitriptyline and nortriptyline (Aventyl, Pamelor) — are the most common preventive medications for all types of chronic daily headaches except hemicrania continua. These medications can also help treat the depression, anxiety and sleep disturbances that often accompany chronic daily headaches. Another antidepressant — such as the selective serotonin reuptake inhibitor (SSRI) fluoxetine (Prozac) — may occasionally be an effective alternative for some people.
- Beta blockers. These drugs, commonly used to treat high blood pressure, are also a mainstay for preventing episodic migraines. Beta blockers include atenolol (Tenormin), metoprolol (Lopressor, Toprol), nadolol (Corgard) and propranolol (Inderal). Sometimes beta blockers are prescribed in combination with antidepressants for better results.
- Anti-seizure medications. Some anti-seizure drugs seem to prevent migraines. Now these medications may be used to prevent chronic daily headaches as well. Options may include divalproex (Depakote), gabapentin (Neurontin) and topiramate (Topamax).
- NSAIDs. Nonsteroidal anti-inflammatory drugs — such as naproxen (Aleve, Anaprox), ketoprofen and mefenamic acid (Ponstel) — may be helpful, especially if you're going through withdrawal from other pain relievers. They may also be used periodically when the headache is more severe.
- Others. Injections of a local anesthetic around a nerve (nerve block) or injections of a numbing agent and corticosteroid at the point of pain (trigger point injections) are sometimes recommended for chronic daily headaches. Although their role needs to be better defined, botulinum toxin type A (Botox) injections provide relief for some people as well.
Unfortunately, some chronic daily headaches remain resistant to all medications.
