Causes of Chronic Headaches
The International Classification of Headache Disorders (ICHD) recognizes over 200 headache disorders and divides them into three groups, which are primary, secondary, and painful cranial neuropathies.[rx] The ICHD system is hierarchical with multiple subtypes within each main headache type.

All chronic headaches meet the criteria of occurring at least 15 times a month for at least 3 months, but both primary and secondary chronic headaches have unique characteristics.

Primary headaches lasting greater than four hours include chronic migraines, tension headaches, new daily persistent headaches, and hemicrania continua.

Chronic migraine has typical migraine features of being unilateral, pulsatile, and moderate to severe and may or may not have an aura.[rx] Episodic migraines may evolve into chronic migraines.

Chronic migraine in children and adolescents is often bilateral, and associated symptoms such as photophobia and phonophobia are often inferred from behavior.[rx]

Chronic headaches, which are bilateral, non-pulsatile, and lack associated symptoms, are classified as chronic tension headaches.[rx] Pericranial tenderness is often found on palpation.

New persistent daily headache (NDPH) occurs suddenly and becomes unremitting within 24 hours of onset. Patients typically have no prior history of headaches. NDPH is rare and refractory to treatment.[rx]

Hemicrania continua is unilateral, has autonomic symptoms, and is continuous with exacerbations. Responsiveness to indomethacin helps distinguish this form of headache.

Primary headaches lasting less than four hours include chronic cluster headache, neuralgiform headache attacks, and primary stabbing headache.

Chronic cluster headache varies from the acute form in that there are no remissions, and headaches must occur over at least one year. Headaches are unilateral in the trigeminal distribution and associated with unilateral autonomic symptoms. Patients often experience agitation during the headache.

The short-lasting neuralgiform headaches include short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA). Both types have severe, unilateral pain associated with autonomic symptoms. SUNCT has both lacrimation and conjunctival injection. SUNA may have either but not both of those features and may be accompanied by rhinorrhea or nasal congestion.

Primary stabbing headaches may frequently occur throughout the day. Sharp, sudden, jabbing pain occurs in the temporal or peri-orbital regions.

Secondary chronic daily headaches include medication overuse, CNS infection, CNS hematomas, intracranial tumor, raised intracranial pressure, low-pressure headache, vasculitis, aneurysms, and cerebrospinal fluid (CSF) leak.[rx]

Chronic medication overuse headaches often overlap with other acute and chronic headache types. Analgesics are widely used for symptom control in migraine and tension headaches. Patients inadvertently increase headache frequency by overuse of analgesics. The ICHD further classifies this disorder based on the medications used, including NSAIDs, triptans, ergotamines, non-opioid, and opioid analgesics.[rx] Withdrawl of analgesics typically worsens these headaches.

The remainder of the secondary chronic headache etiologies is beyond the scope of this article.

Diagnosis of Chronic Headaches
A thorough history and physical exam are indispensable in the diagnosis of chronic daily headaches. As noted above, a chronic headache should have 15 or more episodes per month for at least 3 months. One should determine the frequency, intensity, characteristics of the pain, as well as the aggravating and alleviating factors. Many headache types involve ipsilateral autonomic symptoms such as lacrimation, conjunctival injection, conjunctival edema, ptosis, miosis, nasal congestion, rhinorrhea, etc.

A thorough medication reconciliation, including over-the-counter analgesics, is essential. Patients with medication-overuse headaches often have a primary headache disorder, and they frequently use pain medications.[rx] Medication classes may include non-steroidal anti-inflammatory drugs (NSAIDs), triptans, ergotamines, opioids, or a combination of multiple analgesics. Key historical features include morning headaches, the onset of headaches when medication is delayed, and relief when medication is taken.[rx]

Comorbidities, sleep history, and family history of headaches should also be noted. A secondary headache disorder should be excluded from the history and examination.

Recognition of headache "red flags" is a critical piece in identifying secondary headaches and ordering additional diagnostic testing. Those "red flags" include:[rx]

Age above 50

Significant change in prior headache pattern

Severe, "thunderclap" headache

Systemic illness signs such as fever

Known illness which increases the risk for secondary headaches such as cancer or HIV

Neurologic symptoms

Headaches associated with Valsalva maneuvers

Physical exam findings concerning secondary headache causes include focal neurological deficits, papilledema, bitemporal hemianopia, homonymous hemianopia, decrease visual acuity or increased pain with the Valsalva method.

Primary chronic headaches often lack physical findings but may have autonomic activation or muscle tenderness in the occipital or cervical regions.

Evaluation
In a straightforward chronic primary headache disorder, further evaluation may not be warranted, but many clinicians will advise for baseline laboratory testing and brain imaging to exclude the secondary treatable causes.

Laboratory workup includes a complete blood count to look for infection. Erythrocyte sedimentation rate (ESR) is increased in giant cell arteritis and other vasculitides. A metabolic panel to look for metabolic causes of headache, and endocrine testings to look for pituitary gland abnormalities.

Magnetic resonance imaging (MRI) of the brain is the imaging modality of choice.[rx] A contrast study is often recommended to increase the sensitivity and specificity to detect structural abnormalities. A need for vascular imaging is based on the differential diagnosis. Further studies may be warranted depending upon the underlying cause. These may include positron emission tomography (PET) scan, magnetic resonance spectroscopy (MRS), and/or biopsy. A lumbar puncture may be required if there is suspicion of a CNS infection or idiopathic intracranial hypertension.

Treatment of Chronic Headaches
Treatment and management of chronic headache disorders depend upon the underlying etiology and may require an interprofessional approach.

A patient should maintain a headache journal that will document their headache episodes and any accompanying triggers. If found, stressors should be avoided or minimized.

Chronic Migraine

Chronic migraine treatment should begin with setting the expectation that headache frequency and severity will decrease, but headaches will not be eliminated.

The patient should be counseled that high caffeine intake, sleep deprivation, overuse of analgesics, and comorbid conditions can worsen chronic migraines.

Prophylactic pharmacologic treatment should be used. First-line therapy includes beta-blockers, anticonvulsants, and antidepressants. The most commonly used medications are propranolol, topiramate, and amitriptyline.[rx]

Botulinum toxin A is a Food and Drug Administration (FDA) approved treatment for chronic migraines and is considered second-line therapy.

Monoclonal antibodies that target calcitonin gene-related peptides (CGRP) are the newest development in chronic migraine treatment. Erenumab, fremanezumab, and galcanezumab are approved for chronic migraines, which have failed to respond to other treatments[rx].

Triptans, steroids, NSAIDs, and opioids are often used to abort acute episodes, but routine use of these medications increases the risk of developing a medication-overuse headache.

Patients may also benefit from psychological counseling if anxiety or depression is present.

Manual medicine, such as spinal manipulation and trigger point treatment, may be used as a complementary or alternative therapy.[rx]

In drug-resistant cases, invasive procedures such as sphenopalatine ganglion blockade and occipital nerve blockade may be tried with variable results. Deep brain stimulation (DBS) is also used in some treatment-resistant cases.[rx][rx]

Chronic Tension Headache

Amitriptyline, a tricyclic antidepressant, is recommended as the first-line treatment for chronic tension headaches.

Amitriptyline, in addition to inhibiting the reuptake of serotonin and noradrenaline, also reduces tenderness in pericranial muscles.

Tricyclic antidepressants increase the risk for cardiac arrhythmia, and patients should be screened for cardiovascular disorders prior to initiating therapy. Patients over 40 should undergo an ECG.

Anticonvulsants, such as topiramate and gabapentin, can be considered as second-line treatment.

Addressing the potential musculoskeletal causes of tension headache, treatment with physical therapy, acupuncture, trigger point injections, spinal manipulation, or muscle relaxants may be beneficial.[rx]

Behavioral therapy, including cognitive-behavioral therapy, biofeedback, and relaxation techniques, is particularly helpful for patients with coexisting anxiety or depression.

Medication Overuse Headache

Patient education about the potential for overuse of analgesic medication to lead to headache progression is key. Include the use of over-the-counter analgesics in the discussion.

The physician initiates a preventative medication while simultaneously assisting the patient in discontinuing the causative medication.

Patients may experience withdrawal symptoms of nausea and anxiety for 2 to 10 days when the analgesic medication is discontinued.

There is no consensus on the most appropriate medication for use as bridge therapy following discontinuation of the offending drug. Long-acting NSAIDs, prednisone, dihydroergotamine, and antiemetics are options.[24] The medication should not be from the same class as the offending medication.

Medications that may be effective for prophylaxis include topiramate, amitryptiline, valproic acid, and beta-blockers. The choice of medication should be based upon comorbidities and the primary headache disorder.[25]

Chronic Autonomic Cephalgia

Indomethacin is the drug of choice for paroxysmal hemicrania, hemicrania continua, primary stabbing headache, hypnic headache, and Valsalva-induced headaches (e.g., cough headache, exercise headache).

Verapamil is the drug of choice for the prevention of chronic cluster headaches. Verapamil requires titration to become effective, and glucocorticoids or dihydroergotamine can be used for exacerbations.

Chronic cluster headaches not responsive to pharmacologic therapy can be treated with a non-invasive vagus nerve stimulator or sphenopalatine ganglion microstimulator.[rx]

First-line prophylactic therapy for chronic SUNCT and SUNA is lamotrigine. Topiramate and gabapentin are alternatives.[rx]

Alternative treatment

Changes in lifestyle; must be a commitment from the patient; however, social support is of great importance to improve mental health to help the patient's involvement.

Regular exercise

Yoga

Relaxation training

Cognitive-behavioral therapy

Biofeedback

Reduction of triggers

Detoxification

Butterbur

Melatonin

Children and Headache
Headaches are common in children. Headaches that begin early in life can develop into migraines as the child grows older. Migraines in children or adolescents can develop into tension-type headaches at any time. In contrast to adults with migraines, young children often feel migraine pain on both sides of the head and have headaches that usually last less than 2 hours. Children may look pale and appear restless or irritable before and during an attack. Other children may become nauseous, lose their appetite, or feel pain elsewhere in the body during the headache.

Headaches in children can be caused by a number of triggers, including emotional problems such as the tension between family members, stress from school activities, weather changes, irregular eating and sleep, dehydration, and certain foods and drinks. Of special concern among children are headaches that occur after a head injury or those accompanied by rash, fever, or sleepiness.

It may be difficult to identify the type of headache because children often have problems describing where it hurts, how often the headaches occur, and how long they last. Asking a child with a headache to draw a picture of where the pain is and how it feels can make it easier for the doctor to determine the proper treatment.

Migraine in particular is often misdiagnosed in children. Parents and caretakers sometimes have to be detectives to help determine that a child has a migraine. Clues to watch for include sensitivity to light and noise, which may be suspected when a child refuses to watch television or use the computer, or when the child stops playing to lie down in a dark room. Observe whether or not a child is able to eat during a headache. Very young children may seem cranky or irritable and complain of abdominal pain (abdominal migraine).

Headache treatment in children and teens usually includes rest, fluids, and over-the-counter pain relief medicines. Always consult with a physician before giving headache medicines to a child. Most tension-type headaches in children can be treated with over-the-counter medicines that are marked for children with usage guidelines based on the child's age and weight. Headaches in some children may also be treated effectively using relaxation/behavioral therapy. Children with cluster headaches may be treated with oxygen therapy early in the initial phase of the attacks.
Headache and Sleep Disorders
Headaches are often a secondary symptom of a sleep disorder. For example, tension-type headache is regularly seen in persons with insomnia or sleep-wake cycle disorders. Nearly three-fourths of individuals who suffer from narcolepsy complain of either migraine or cluster headache. Migraines and cluster headaches appear to be related to the number of and transition between rapid eye movement (REM) and other sleep periods an individual has during sleep. Hypnic headache awakens individuals mainly at night but may also interrupt daytime naps. Reduced oxygen levels in people with sleep apnea may trigger early morning headaches.

Getting the proper amount of sleep can ease headache pain. Generally, too little or too much sleep can worsen headaches, as can the overuse of sleep medicines. Daytime naps often reduce deep sleep at night and can produce headaches in some adults. Some sleep disorders and secondary headaches are treated using antidepressants. Check with a doctor before using over-the-counter medicines to ease sleep-associated headaches.
Coping with Headache
Headache treatment is a partnership between you and your doctor, and honest communication is essential. Finding a quick fix to your headache may not be possible. It may take some time for your doctor or specialist to determine the best course of treatment. Avoid using over-the-counter medicines more than twice a week, as they may actually worsen headache pain and the frequency of attacks. Visit a local headache support group meeting (if available) to learn how others with headaches cope with their pain and discomfort. Relax whenever possible to ease stress and related symptoms, get enough sleep, regularly perform aerobic exercises, and eat a regularly scheduled and healthy diet that avoids food triggers. Gaining more control over your headache, stress, and emotions will make you feel better and let you embrace daily activities as much as possible.
What Research is Being Done?

Question

Causes of Chronic Headaches
The International Classification of Headache Disorders (ICHD) recognizes over 200 headache disorders and divides them into three groups, which are primary, secondary, and painful cranial neuropathies.[rx] The ICHD system is hierarchical with multiple subtypes within each main headache type.

All chronic headaches meet the criteria of occurring at least 15 times a month for at least 3 months, but both primary and secondary chronic headaches have unique characteristics.

Primary headaches lasting greater than four hours include chronic migraines, tension headaches, new daily persistent headaches, and hemicrania continua.

 	
Chronic migraine has typical migraine features of being unilateral, pulsatile, and moderate to severe and may or may not have an aura.[rx] Episodic migraines may evolve into chronic migraines.
 	
Chronic migraine in children and adolescents is often bilateral, and associated symptoms such as photophobia and phonophobia are often inferred from behavior.[rx]
 	
Chronic headaches, which are bilateral, non-pulsatile, and lack associated symptoms, are classified as chronic tension headaches.[rx] Pericranial tenderness is often found on palpation.
 	
New persistent daily headache (NDPH) occurs suddenly and becomes unremitting within 24 hours of onset. Patients typically have no prior history of headaches. NDPH is rare and refractory to treatment.[rx]
 	
Hemicrania continua is unilateral, has autonomic symptoms, and is continuous with exacerbations. Responsiveness to indomethacin helps distinguish this form of headache.

Primary headaches lasting less than four hours include chronic cluster headache, neuralgiform headache attacks, and primary stabbing headache.

 	
Chronic cluster headache varies from the acute form in that there are no remissions, and headaches must occur over at least one year. Headaches are unilateral in the trigeminal distribution and associated with unilateral autonomic symptoms. Patients often experience agitation during the headache.
 	
The short-lasting neuralgiform headaches include short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA). Both types have severe, unilateral pain associated with autonomic symptoms. SUNCT has both lacrimation and conjunctival injection. SUNA may have either but not both of those features and may be accompanied by rhinorrhea or nasal congestion.
 	
Primary stabbing headaches may frequently occur throughout the day. Sharp, sudden, jabbing pain occurs in the temporal or peri-orbital regions.

Secondary chronic daily headaches include medication overuse, CNS infection, CNS hematomas, intracranial tumor, raised intracranial pressure, low-pressure headache, vasculitis, aneurysms, and cerebrospinal fluid (CSF) leak.[rx]

 	
Chronic medication overuse headaches often overlap with other acute and chronic headache types. Analgesics are widely used for symptom control in migraine and tension headaches. Patients inadvertently increase headache frequency by overuse of analgesics. The ICHD further classifies this disorder based on the medications used, including NSAIDs, triptans, ergotamines, non-opioid, and opioid analgesics.[rx] Withdrawl of analgesics typically worsens these headaches.
 	
The remainder of the secondary chronic headache etiologies is beyond the scope of this article.



Diagnosis of Chronic Headaches
A thorough history and physical exam are indispensable in the diagnosis of chronic daily headaches. As noted above, a chronic headache should have 15 or more episodes per month for at least 3 months. One should determine the frequency, intensity, characteristics of the pain, as well as the aggravating and alleviating factors. Many headache types involve ipsilateral autonomic symptoms such as lacrimation, conjunctival injection, conjunctival edema, ptosis, miosis, nasal congestion, rhinorrhea, etc.

A thorough medication reconciliation, including over-the-counter analgesics, is essential. Patients with medication-overuse headaches often have a primary headache disorder, and they frequently use pain medications.[rx] Medication classes may include non-steroidal anti-inflammatory drugs (NSAIDs), triptans, ergotamines, opioids, or a combination of multiple analgesics. Key historical features include morning headaches, the onset of headaches when medication is delayed, and relief when medication is taken.[rx]

Comorbidities, sleep history, and family history of headaches should also be noted. A secondary headache disorder should be excluded from the history and examination.

Recognition of headache "red flags" is a critical piece in identifying secondary headaches and ordering additional diagnostic testing. Those "red flags" include:[rx]

 	
Age above 50
 	
Significant change in prior headache pattern
 	
Severe, "thunderclap" headache
 	
Systemic illness signs such as fever
 	
Known illness which increases the risk for secondary headaches such as cancer or HIV
 	
Neurologic symptoms
 	
Headaches associated with Valsalva maneuvers

Physical exam findings concerning secondary headache causes include focal neurological deficits, papilledema, bitemporal hemianopia, homonymous hemianopia, decrease visual acuity or increased pain with the Valsalva method.

Primary chronic headaches often lack physical findings but may have autonomic activation or muscle tenderness in the occipital or cervical regions.



Evaluation
In a straightforward chronic primary headache disorder, further evaluation may not be warranted, but many clinicians will advise for baseline laboratory testing and brain imaging to exclude the secondary treatable causes.

Laboratory workup includes a complete blood count to look for infection. Erythrocyte sedimentation rate (ESR) is increased in giant cell arteritis and other vasculitides. A metabolic panel to look for metabolic causes of headache, and endocrine testings to look for pituitary gland abnormalities.

Magnetic resonance imaging (MRI) of the brain is the imaging modality of choice.[rx] A contrast study is often recommended to increase the sensitivity and specificity to detect structural abnormalities. A need for vascular imaging is based on the differential diagnosis. Further studies may be warranted depending upon the underlying cause. These may include positron emission tomography (PET) scan, magnetic resonance spectroscopy (MRS), and/or biopsy. A lumbar puncture may be required if there is suspicion of a CNS infection or idiopathic intracranial hypertension.



Treatment of Chronic Headaches
Treatment and management of chronic headache disorders depend upon the underlying etiology and may require an interprofessional approach.

A patient should maintain a headache journal that will document their headache episodes and any accompanying triggers. If found, stressors should be avoided or minimized.

Chronic Migraine

 	
Chronic migraine treatment should begin with setting the expectation that headache frequency and severity will decrease, but headaches will not be eliminated.
 	
The patient should be counseled that high caffeine intake, sleep deprivation, overuse of analgesics, and comorbid conditions can worsen chronic migraines.
 	
Prophylactic pharmacologic treatment should be used. First-line therapy includes beta-blockers, anticonvulsants, and antidepressants. The most commonly used medications are propranolol, topiramate, and amitriptyline.[rx]
 	
Botulinum toxin A is a Food and Drug Administration (FDA) approved treatment for chronic migraines and is considered second-line therapy.
 	
Monoclonal antibodies that target calcitonin gene-related peptides (CGRP) are the newest development in chronic migraine treatment. Erenumab, fremanezumab, and galcanezumab are approved for chronic migraines, which have failed to respond to other treatments[rx].
 	
Triptans, steroids, NSAIDs, and opioids are often used to abort acute episodes, but routine use of these medications increases the risk of developing a medication-overuse headache.
 	
Patients may also benefit from psychological counseling if anxiety or depression is present.
 	
Manual medicine, such as spinal manipulation and trigger point treatment, may be used as a complementary or alternative therapy.[rx]
 	
In drug-resistant cases, invasive procedures such as sphenopalatine ganglion blockade and occipital nerve blockade may be tried with variable results. Deep brain stimulation (DBS) is also used in some treatment-resistant cases.[rx][rx]

Chronic Tension Headache

 	
Amitriptyline, a tricyclic antidepressant, is recommended as the first-line treatment for chronic tension headaches.
 	
Amitriptyline, in addition to inhibiting the reuptake of serotonin and noradrenaline, also reduces tenderness in pericranial muscles.
 	
Tricyclic antidepressants increase the risk for cardiac arrhythmia, and patients should be screened for cardiovascular disorders prior to initiating therapy. Patients over 40 should undergo an ECG.
 	
Anticonvulsants, such as topiramate and gabapentin, can be considered as second-line treatment.
 	
Addressing the potential musculoskeletal causes of tension headache, treatment with physical therapy, acupuncture, trigger point injections, spinal manipulation, or muscle relaxants may be beneficial.[rx]
 	
Behavioral therapy, including cognitive-behavioral therapy, biofeedback, and relaxation techniques, is particularly helpful for patients with coexisting anxiety or depression.

Medication Overuse Headache

 	
Patient education about the potential for overuse of analgesic medication to lead to headache progression is key. Include the use of over-the-counter analgesics in the discussion.
 	
The physician initiates a preventative medication while simultaneously assisting the patient in discontinuing the causative medication.
 	
Patients may experience withdrawal symptoms of nausea and anxiety for 2 to 10 days when the analgesic medication is discontinued.
 	
There is no consensus on the most appropriate medication for use as bridge therapy following discontinuation of the offending drug. Long-acting NSAIDs, prednisone, dihydroergotamine, and antiemetics are options.[24] The medication should not be from the same class as the offending medication.
 	
Medications that may be effective for prophylaxis include topiramate, amitryptiline, valproic acid, and beta-blockers. The choice of medication should be based upon comorbidities and the primary headache disorder.[25]

Chronic Autonomic Cephalgia

 	
Indomethacin is the drug of choice for paroxysmal hemicrania, hemicrania continua, primary stabbing headache, hypnic headache, and Valsalva-induced headaches (e.g., cough headache, exercise headache).
 	
Verapamil is the drug of choice for the prevention of chronic cluster headaches. Verapamil requires titration to become effective, and glucocorticoids or dihydroergotamine can be used for exacerbations.
 	
Chronic cluster headaches not responsive to pharmacologic therapy can be treated with a non-invasive vagus nerve stimulator or sphenopalatine ganglion microstimulator.[rx]
 	
First-line prophylactic therapy for chronic SUNCT and SUNA is lamotrigine. Topiramate and gabapentin are alternatives.[rx]

Alternative treatment



 	
Changes in lifestyle; must be a commitment from the patient; however, social support is of great importance to improve mental health to help the patient's involvement.
 	
Regular exercise
 	
Yoga
 	
Relaxation training
 	
Cognitive-behavioral therapy
 	
Biofeedback
 	
Reduction of triggers
 	
Detoxification
 	
Butterbur
 	
Melatonin




Children and Headache
Headaches are common in children. Headaches that begin early in life can develop into migraines as the child grows older. Migraines in children or adolescents can develop into tension-type headaches at any time. In contrast to adults with migraines, young children often feel migraine pain on both sides of the head and have headaches that usually last less than 2 hours. Children may look pale and appear restless or irritable before and during an attack. Other children may become nauseous, lose their appetite, or feel pain elsewhere in the body during the headache.

Headaches in children can be caused by a number of triggers, including emotional problems such as the tension between family members, stress from school activities, weather changes, irregular eating and sleep, dehydration, and certain foods and drinks. Of special concern among children are headaches that occur after a head injury or those accompanied by rash, fever, or sleepiness.

It may be difficult to identify the type of headache because children often have problems describing where it hurts, how often the headaches occur, and how long they last. Asking a child with a headache to draw a picture of where the pain is and how it feels can make it easier for the doctor to determine the proper treatment.

Migraine in particular is often misdiagnosed in children. Parents and caretakers sometimes have to be detectives to help determine that a child has a migraine. Clues to watch for include sensitivity to light and noise, which may be suspected when a child refuses to watch television or use the computer, or when the child stops playing to lie down in a dark room. Observe whether or not a child is able to eat during a headache. Very young children may seem cranky or irritable and complain of abdominal pain (abdominal migraine).

Headache treatment in children and teens usually includes rest, fluids, and over-the-counter pain relief medicines. Always consult with a physician before giving headache medicines to a child. Most tension-type headaches in children can be treated with over-the-counter medicines that are marked for children with usage guidelines based on the child's age and weight. Headaches in some children may also be treated effectively using relaxation/behavioral therapy. Children with cluster headaches may be treated with oxygen therapy early in the initial phase of the attacks.
Headache and Sleep Disorders
Headaches are often a secondary symptom of a sleep disorder. For example, tension-type headache is regularly seen in persons with insomnia or sleep-wake cycle disorders. Nearly three-fourths of individuals who suffer from narcolepsy complain of either migraine or cluster headache. Migraines and cluster headaches appear to be related to the number of and transition between rapid eye movement (REM) and other sleep periods an individual has during sleep. Hypnic headache awakens individuals mainly at night but may also interrupt daytime naps. Reduced oxygen levels in people with sleep apnea may trigger early morning headaches.

Getting the proper amount of sleep can ease headache pain. Generally, too little or too much sleep can worsen headaches, as can the overuse of sleep medicines. Daytime naps often reduce deep sleep at night and can produce headaches in some adults. Some sleep disorders and secondary headaches are treated using antidepressants. Check with a doctor before using over-the-counter medicines to ease sleep-associated headaches.
Coping with Headache
Headache treatment is a partnership between you and your doctor, and honest communication is essential. Finding a quick fix to your headache may not be possible. It may take some time for your doctor or specialist to determine the best course of treatment. Avoid using over-the-counter medicines more than twice a week, as they may actually worsen headache pain and the frequency of attacks. Visit a local headache support group meeting (if available) to learn how others with headaches cope with their pain and discomfort. Relax whenever possible to ease stress and related symptoms, get enough sleep, regularly perform aerobic exercises, and eat a regularly scheduled and healthy diet that avoids food triggers. Gaining more control over your headache, stress, and emotions will make you feel better and let you embrace daily activities as much as possible.
What Research is Being Done?

Accepted Answer

Several studies either conducted or supported by the National Institute of Neurological Disorders and Stroke (NINDS), a part of the National Institutes of Health, are revealing much about the headache process and may lead to new treatments or perhaps ways to block debilitating headache pain. Studies by other investigators are adding insight to headache etiology and treatment. Understanding headache mechanisms and underlying causes The molecular basis for migraine headaches and the aura associated with certain migraines is uncertain. One multi-faceted&hellip;

Read, save, and share this guide

Understand this article easily

Seek urgent medical care if you notice

Emergency now

See a doctor

Learn safely

RX Patient Tools