- Brain tumors
- Meningitis (infection of the lining of the brain)
- Systemic infection
- Some medications, vitamins, herbs, supplements
- Sleep apnea
- Severe sinus disease
Neurologists in general consider headaches that are more often than 15 days per month to be a daily headache. Patients with daily headaches or near daily headaches need a significant evaluation to determine if the daily headache is only a symptom of a more serious cause. Studies commonly performed include imaging, blood work, and spinal taps (also known as a lumbar puncture or spinal fluid analysis). Some of the causes of daily headaches include the following:
Rebound headaches are headaches that are caused by the overuse of acute pain medications. With the possible exception of aspirin, there is no acute headache medication that cannot cause rebound headaches. Medications least likely to cause rebound headaches are the various forms of dihydroergotamine. Medications that commonly cause rebound include those that contain butalbital and narcotics.
Occasionally, patients who have never had a history of intermittent headaches of any type suddenly begin having persistent daily headaches. Because they are not using pain medication, these are not rebound headaches. In the current International Classification of Headache Diseases, only those headaches that appear to be tension type are called New Daily Persistent Headaches. At the present time if the headaches have migraine features, they are considered Chronic Migraine Headaches.
There are a large group of patients who begin with relatively infrequent migraine headaches that overtime become more frequent. When the headaches are 50% of the days, the patient should be treated as chronic migraine. Most migraine patients have headaches on some days that are tension type and some that fall between tension headaches and migraine headaches. All of their headaches are related to their migraine disease and need to be treated as such.
There is a small number of patients with intermittent tension type headaches that become to be more than 50%of the days of the month. These patients have chronic tension type headaches. A high percentage of patients thought to have chronic tension type headaches actually have chronic migraines. An active diary like iHeadache is crucial to identify these patients.
Most cluster patients have periods of time when their clusters are present and other extended periods of time when they are free from headaches. A subset of cluster headache patients develop a cycle of cluster that last for more than a year. At this point, they are considered to have chronic cluster headaches.
Hemicrania Continua is another form of primary headache that leads to daily headache. It is a headache that when severe is similar to a cluster headache but the patient is never headache free. To complete the diagnosis, these patients must get better with indomethacin.
This educational content was written by Brian D. Loftus, MD, a neurologist, headache specialist and a developer of iHeadache. The science and study of headaces is changing rapidly. If there is information on this page that is incorrect or needs revision, please contact us.
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