Chronic headache, or chronic daily headache (CDH), is classified as experiencing fifteen or more days with a headache per month.Duckro, Paul N. Taking Control of Your Headaches: How to Get the Treatment You Need p. 6 It is estimated that chronic headaches affect "4% to 5% of the general population".Mathew, Ninan T. "The Prophylactic Treatment of Chronic Daily Headache" p. 1552 Chronic headaches consist of different sub-groups, primarily categorized as chronic tension-type headaches and chronic migraine headaches. The treatments for chronic headache are vast and varied. Medicinal and non-medicinal methods exist to help patients cope with chronic headache, because chronic headaches cannot be cured.Duckro, Paul N. Taking Control of Your Headaches: How to Get the Treatment You Need p. 136 Whether pharmacological or not, treatment plans are often created on an individual basis.Harpole, Linda H., et al. "Headache Management Program Improves Outcome for Chronic Heachache" p. 716 Multiple sources recommend multimodal treatment, which is a combination of medicinal and non-medicinal remedies.Duckro, Paul N. Taking Control of Your Headaches: How to Get the Treatment You Need p. 40, "Success with Biofeedback found in Chronic Headache Treatment", Andrasik, F. "Behavioral Treatment Approaches to Chronic Headache" p. S81 Some treatments are controversial and are still being tested for effectiveness. Suggested treatments for chronic headaches include medication, physical therapy, acupuncture, relaxation training, and biofeedback. In addition, dietary alteration and behavioral therapy or psychological therapy are other possible treatments for chronic headaches.
Medicinal
Analgesic and abortive medications The most common chronic treatment method is the use of medicine. Many people try to seek pain relief from analgesic medicines (commonly termed pain killers), such as aspirin, acetaminophen, aspirin compounds, ibuprofen, and opioids.Duckro, Paul N. Taking Control of Your Headaches: How to Get the Treatment You Need p. 88, 95 The long term use of opioids; however, appears to result in greater harm than benefit. Also, abortive medications can be used to "stop a headache once it has begun"; such drugs include CGRP receptor antagonists (Ubrelvy, Nurtec ODT), ergotamine (Cafergot), triptans (Imitrex), and prednisone (Deltasone).Duckro, Paul N. Taking Control of Your Headaches: How to Get the Treatment You Need p. 89, 94 However, medical professionals advise that abuse of analgesics and abortive medications can actually lead to an increase in headaches.Duckro, Paul N. Taking Control of Your Headaches: How to Get the Treatment You Need p. 24 The painkiller medicines help headaches temporarily, but as the "quick fix" wears off, headaches become more re-current and grow in intensity.Buchholz, David. Heal Your Headache: The 1-2-3 Program for Taking Charge of Your Headaches p. 46 These "rebound headaches" can actually make the body less responsive to preventive medication.Buchholz, David. Heal Your Headache: The 1-2-3 Program for Taking Charge of Your Headaches p. 50 The conditions keep worsening if one takes paracetamol, aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) for 15 days a month or more. Therefore, those with chronic migraine are left with more migraine days per month than can be safely controlled with analgesic and abortive medications.
Preventive medications The most common medicines used to treat chronic (daily) headaches are called prophylactic medicines, which are used to prevent headaches.Duckro, Paul N. Taking Control of Your Headaches: How to Get the Treatment You Need p. 95 Such preventive medication is taken on a daily basis, even when a person may not have a headache. Prophylactic medicines are recommended for chronic headache patients because varied experiments prove that the medications "reduce the frequency, severity, and disability associated with daily headaches".Mathew, Ninan T. "The Prophylactic Treatment of Chronic Daily Headache" p. 1553 A majority of the prophylactic medications work by inhibiting or increasing neurotransmissions in the brain, often preventing the brain from interpreting pain signals.Mathew, Ninan T. "The Prophylactic Treatment of Chronic Daily Headache" p. 1553-1560
Preventive medicines include CGRP receptor antagonists, gabapentin (Neurontin), tizanidine (Zanaflex), fluoxetine (Prozac), amitriptyline (Elavil), and topiramate (Topamax). In testing, gabapentin was found to reduce the number of headache days a month by 9.1%. Tizanidine was found to decrease the average frequency of headaches per week, the headache intensity, and the mean headache duration.Mathew, Ninan T. "The Prophylactic Treatment of Chronic Daily Headache" p. 1554 Through studies, Fluoxetine resulted in better mood ratings and "significant increases in headache-free days".Mathew, Ninan T. "The Prophylactic Treatment of Chronic Daily Headache" p. 1557 Despite being associated with depression, antidepressants, such as amitriptyline, have been found to effectively treat "near-daily headaches" and numerous chronic pain conditions as well as improving mood and sleep—two possible triggers for people with chronic headaches.Duckro, Paul N. Taking Control of Your Headaches: How to Get the Treatment You Need p. 99 One study found that the headache frequency over a 28-day period lowered for chronic headache patients on topiramate.Mathew, Ninan T. "The Prophylactic Treatment of Chronic Daily Headache" p. 1558 Another medication to prevent headaches is botulinum toxin type A (BoNTA or BOTOX), which is given by injection instead of being taken orally.Mathew, Ninan T. "The Prophylactic Treatment of Chronic Daily Headache" p. 1553-1558 In a clinical study of botulinum toxin type A, patients participating in the 9-month treatment period with three treatments experienced headache frequency decreases up to 50%.Mathew, Ninan T. "The Prophylactic Treatment of Chronic Daily Headache" p. 1559 As with all medications, the preventive medications may have side effects. Since different people respond to drugs differently, people with chronic headaches may have to go through a "trial-and-error" period to find the right medications.Duckro, Paul N. Taking Control of Your Headaches: How to Get the Treatment You Need p. 91 The previously mentioned medicines can improve headaches, but physicians recommend multiple forms of treatments.
Non-medicinal
Physical therapy In addition to medicines, physical therapy is a treatment to help improve chronic headaches. In physical therapy, a patient works together with a therapist to help identify and change physical habits or conditions that affect chronic headaches. Physical therapy for chronic daily headaches focuses on the upper body, including the upper back, neck, and face.Duckro, Paul N. Taking Control of Your Headaches: How to Get the Treatment You Need p. 109 Therapists assess and improve the patient's body posture, which can aggravate headaches.Duckro, Paul N. Taking Control of Your Headaches: How to Get the Treatment You Need p. 111 During office sessions, therapists use manual therapy, such as a massage, stretching, or joint movement to release muscle tension.Duckro, Paul N. Taking Control of Your Headaches: How to Get the Treatment You Need p. 113 Other methods to relax muscles include heat packs, ice packs, and "electrical stimulation". Therapists also teach people with chronic headaches at-home exercises to strengthen and stretch muscles that may be triggering headaches. In physical therapy, the patient must take an active role to practice exercises and make changes to their lifestyle for there to be improvement.
Acupuncture Another non-medicinal treatment, which does not require at-home exercises, is acupuncture. Acupuncture involves a certified acupuncturist picking particular points on the body to insert acupuncture needles; these points may differ on an individual basis.Coeytaux, Remy R., et al. "A Randomized, Controlled Trial of Acupuncture for Chronic Daily Headache" p. 1115 With chronic headache patients, the acupuncturist may needle "tender points at or near the site of maximal headache pain". A study conducted by the University of North Carolina School of Medicine found that compared to medicinal treatment alone, medicinal treatment plus acupuncture resulted in more improvement for chronic daily headache patients.Coeytaux, Remy R., et al. "A Randomized, Controlled Trial of Acupuncture for Chronic Daily Headache" p. 1121 Another acupuncture study in Germany found that 52.6% of patients reported a decrease in headache frequencyMelchart, Dieter, et al. "Acupuncture for Chronic Headaches--an Epidemiological Study" p. 636 In both studies, acupuncture was not the only treatment. Trials show that acupuncture can cause "relevant improvements" for people with chronic headaches.Melchart, Dieter, et al. "Acupuncture for Chronic Headaches--an Epidemiological Study" p. 632
Relaxation training Relaxation training is another form of non-pharmacological treatment for chronic headache. Relaxation training helps to reduce internal tension, allowing a person to control headaches triggered by stress.Duckro, Paul N. Taking Control of Your Headaches: How to Get the Treatment You Need p. 117 The different relaxation methods are normally taught by a psychologist or a therapist.Duckro, Paul N. Taking Control of Your Headaches: How to Get the Treatment You Need p. 122 Relaxation training works as people become in tune with their own body, allowing them to realize when it is necessary to decrease tension before a headache occurs. The point of relaxation training is to teach people "an attitude of consciously setting out to relax but not trying too hard", enabling people to relax in everyday situations.Duckro, Paul N. Taking Control of Your Headaches: How to Get the Treatment You Need p. 123 Relaxation training includes two different types of methods: physical and mental.
Physical methods Physical relaxation methods involve actual body movement or action. One physical method for releasing tension involves "purposefully tensing and then relaxing groups of muscles in a definite sequence", which is named accordingly progressive muscle relaxation.Duckro, Paul N. Taking Control of Your Headaches: How to Get the Treatment You Need p. 124 Another physical method of relaxation is deep breathing.Duckro, Paul N. Taking Control of Your Headaches: How to Get the Treatment You Need p. 125 Deep breathing is done by breathing from the bottom of the lungs up, which is characterized by the rise and fall of the stomach, not the chest.Duckro, Paul N. Taking Control of Your Headaches: How to Get the Treatment You Need p. 125-126 These are the two most common physical methods of relaxation for people with chronic headaches.
Mental methods