Epilepsy MUSC

Comprehensive Epilepsy Center

Chronic Daily Headaches

Information on chronic headaches, therapies and preventive measures.

What are chronic daily headaches?
Chronic daily headaches are headaches that occur 15 days out of the month for more than 3 months and last 4 hours or more daily.
About 1% of adolescents have chronic daily headaches.
Individuals can get chronic daily headaches from overusing medications such as acetaminophen or ibuprofen.
Most people with chronic daily headaches have a continuous or baseline headache all the time that gets better or worse at certain times of day. In addition to the baseline headache, the person may also have severe migraine headaches several times a week. Individuals with migraines may have scalp or face tenderness, dizziness, sleep disturbance, fatigue,  difficulty concentrating, or a sad mood.

Biobehavioral Treatment
A healthy lifestyle is key to dealing with chronic daily headaches. Oftentimes, medications alone are unsuccessful, and the individual must change his/her lifestyle in order to win the battle against these headaches. The following are recommended ways to improve your daily life:

  • Regulate your sleep cycle (8-10 hours of sleep each night; no daytime naps; going to bed the same time each night; do not watch television in bed).
  • Eat 3 healthy meals each day.
  • Weight loss, if you are overweight (Body Mass Index > 24). A referral to a nutritionist may be needed.
  • Regular exercise (30 minutes of exercise that makes you sweat 5 days per week).
  • Avoid caffeine
  • Stay hydrated with non-caffeinated liquids. Carry a water bottle to class (We can provide a school letter, if needed).
  • Do not chew gum.
  • Do not carry heavy backpacks.
  • Stress management (Talking to a counselor or psychologist may help you learn ways to handle stressful times).

Additional treatment options to complement medication and/or lifestyle changes

With this technique, an individual is trained to improve his/ her health by learning to control certain internal bodily processes such as heart rate, blood pressure, and muscle tension. This type of therapy is often used to treat migraines, chronic daily headaches, and insomnia.

  • Relaxation Therapy
  • Counseling or Behavioral Therapy
  • Nutrition Management
  • Physical Therapy
  • Preventative Therapy

These are medications to be taken daily to reduce the frequency and severity of the headaches. These medications are prescribed when the headaches are frequent and disabling. These medications take time to work, and they are rarely able to completely do away with all of your headaches. The goal of preventative medicine is a 50% reduction in how severe the headaches are and how often the headaches occur.
In addition to prescription medication, certain vitamin supplements have been used to prevent headaches. These supplements, like prescription medications, take time to work. Supplements used include magnesium, coenzyme Q10, riboflavin, feverfew, and butterbur. Talk to your healthcare provider before starting any of these supplements.

Abortive/Rescue Therapy:
Abortive or rescue medications can be useful in patients with chronic daily headaches, if used properly. Most rescue medications are analgesics (such as acetaminophen or ibuprofen). You should limit the use of rescue medications for the 2-3 day s per week when the headaches are most severe. The type and dose of the rescue medication to be used should be discussed by you and your health care provider. Some individuals with chronic daily headaches get their headaches from using too many analgesics. If this is the case, an analgesic free period may be necessary. In general, rescue medications should not be  used more than 3 days per week.

Diet and Headaches:
Diet can play an important role in headache management. Individuals with headaches may be sensitive to certain foods, beverages, or food additives. In addition, dehydration and skipped meals also trigger headaches. You may want to note which foods you ate around the time of your headache and try eliminating
those foods from your diet. You also have the option of trying a very strict elimination diet with the help of a dietician.

Common Dietary Triggers for Headaches:

  • Caffeine (coffee, tea, soda)
  • Chocolate
  • MSG and soy products (often found in Asian foods, soups, salty snacks, processed meats, croutons)
  • Nitrite-containing foods (hot dogs, cured meat, ham, bologna, pepperoni, sausage)
  • Some cheeses/dairy (aged cheeses, yogurt, sour cream, buttermilk, whole milk, ice cream)
  • Nuts and nut butter (peanut butter, peanuts)
  • Vinegar and condiments made with vinegar (ketchup, mustard, mayonnaise)
  • Certain fruits/juices (citrus fruit, raisins, raspberries, red plums, papayas, passion fruit, dates, avocados)
  • Certain vegetables (sauerkraut, pea pods, lima beans, fava beans, navy beans, lentils)
  • Fresh yeast in baked goods (sourdough, bagels, doughnuts, pizza dough, soft pretzels, coffee cake)
  • Artificial sweeteners (Saccharin, aspartame)
  • Snack foods (chips, TV dinners)
  • Wine and beer (although individuals under 21 years of age should not be consuming these beverages)

Safe Alternative Foods:

  • American or cottage cheese, low-fat milk
  • Rice cereal, potatoes, pasta
  • Lamb, chicken
  • Broccoli, cabbage, cauliflower
  • Apples
  • Jelly, jam, honey, hard candy
  • Sherbet, cookies, gelatin

Helpful Websites:
American Headache Society  
National Headache Foundation 
Migraine Action for Kids


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