Chronic headache

Those who have more than half of the days a month with headaches over a longer period (over 3 months) have chronic headaches.

Chronic headaches usually result in a significantly reduced quality of life. Prevention is key, and if it does occur, the right treatment must be initiated as soon as possible.

1

Chronic headaches affect 3-5% of the population and include types such as chronic migraine, tension headaches, and medication overuse headaches.

2

Symptoms include constant or recurring pain, often accompanied by nausea and sensitivity to light, and greatly affect quality of life.

3

Note that there is a lot of overlap between chronic migraine and chronic tension headache in symptoms, but correct diagnosis is crucial for proper treatment and rights.

How common is chronic headache?

Chronic headache affects approximately 3–5% of the global population. It is more common in women than in men and can affect individuals of all ages.

What types of chronic headache exists?

Chronic headache can be either primary (such as migraine and tension-type headache) or secondary (resulting from other medical conditions).

Chronic migraine: Headache occurring more than 15 days per month for over 3 months, with at least 8 days per month involving migraine attacks. It affects approximately 2% of the population.

Chronic tension-type headache: Headache occurring 15 days per month or more, over a period of more than 3 months. It affects around 2–3% of the population.

Medication-overuse headache (MOH): Headache occurring 15 days per month or more, over 3 months or longer. It affects about 1–2% of the population and is a secondary headache resulting from frequent use of pain-relieving medications.

Other chronic headaches: In theory, any headache can become chronic, but other more common types besides those listed above include new daily persistent headache (NDPH), hemicrania continua, cluster headache, and post-traumatic headache.

What symptoms are typical for chronic headaches?

The symptoms vary depending on the type of headache but often include:

  • Constant or recurring pain on one or both sides of the head

  • Throbbing or pressing pain

  • Nausea or vomiting

  • Sensitivity to light, sound, or smell

  • Poor concentration

  • Reduced level of functioning

  • Decreased quality of life

  • Dizziness

What mechanisms are behind chronic headaches?

The exact mechanisms behind chronic headache are not fully understood but are believed to involve:

  • Overactivation of the brain’s pain network, along with central and peripheral sensitization

  • Dysfunction of the trigeminovascular system

  • Hormonal imbalances

  • Genetic factors

  • Persistent stress or anxiety

Duration

To be classified as chronic, the headache must occur at least 15 days per month over a period of three months or more. The duration of each episode can vary from hours to days. Chronic headache is considered a continuum, where one symptom transitions into another. Typically, some days may involve fatigue and mood swings, while other days may present with tension-type headache and/or migraine. Read more about chronic migraine here.

Frequency

The frequency of chronic headache can vary significantly:

  • Daily episodes

  • Several times a week

  • Periods of intensified symptoms followed by periods with fewer symptoms

What triggers chronic headaches?

Common triggers include:

  • Disruptions in routine

  • Stress

  • Lack of sleep

  • Hormonal changes

  • Too little or too much physical activity

  • Dietary factors such as alcohol or certain foods

  • Environmental factors such as light, noise, or weather changes

How do you obtain the chronic headache diagnosis?

The diagnosis is based on:

  • The patient’s medical history and headache diary

  • Physical examination

  • Neurological assessment

  • Exclusion of secondary causes through blood tests, imaging (such as MRI or CT), and other investigations

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Treatment and
prevention

Treatment and prevention are adapted both medically and non-medically according to the relevant diagnosis. Some of the medications can be prescribed by the general practitioner, but the more expensive medications that are eligible for reimbursement must be prescribed by a neurologist. There are more rights for reimbursement with chronic migraine than there are for chronic tension headache.

Attack medication:

  • Painkillers (paracetamol, NSAIDs).
  • Triptans for migraine.
  • Medication overuse headache (MOH): Treatment often involves cutting out medications that are overused to reduce headache frequency.

Preventive medication:

  • Avoid medication overuse: Be cautious about frequent use of pain medication to avoid the development of medication overuse headache (MOH).
  • Chronic migraine: Prophylactic medications (antihypertensives, beta-blockers, antiepileptics, antidepressants), Botox injections, CGRP inhibitors.

Non-medical prevention:

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