Having persistent headaches adds insult to quite literal injury. While pretty much everyone gets the occasional twinge of head pain, dealing with constant headaches can make it seem like your brain is turning against you.
Still, it can be hard to know when to raise a red flag for your doctor. Here’s what you need to know about persistent headaches, plus signs that you should seek medical help. Sometimes it’s inconvenient, but it’s often the best thing you can do for yourself.
All head pain sucks. But for your persistent headaches to count as chronic, they need to happen for 15 days or more a month and for longer than three months.
That’s according to the Mayo Clinic, if you were wondering. This is not to say that having had head pain for “only” 14 days last month means everything’s copacetic. You came here to know when to see a doctor, and in short, it’s when you’re dealing with any head pain that’s really interfering with your daily functioning or enjoyment of life. But that 15-plus days a month for three months or longer rule is a good benchmark to have in mind.
Underneath the umbrella of chronic head pain, there are four general categories:
Let’s start with the hellish beast known as the migraine experience. This type of head pain can affect one or both sides of your head, where it will cause an exquisitely unpleasant pulsing or throbbing sensation and moderate to severe pain, according to the Mayo Clinic. That’s not all; migraines can also cause nausea, vomiting, sensitivity to light and sound, aura (sensory changes that can make you see zigzags and other weird things), and more.
The cause of migraines is something of a mystery. It seems to be due at least in part to changes in your brainstem and how it works with the trigeminal nerve, a pain pathway that provides sensation to your head and face, the Mayo Clinic explains. Imbalances in your brain chemicals, including serotonin (which helps regulate pain), may also be a factor.
Chronic tension-type headache
Tension-type headaches can cause mild to moderate pain that feels like something is applying dull, achy pressure around your entire head, the Mayo Clinic says. You might also deal with soreness in your scalp, neck, and shoulders. Doctors don’t know why some people get these headaches, but the general theory is that people who get them have a heightened sensitivity to pain.
New daily persistent headache
As you might guess from the name, this kind of head pain usually afflicts people who don’t have a history of headaches, the Mayo Clinic says. It can affect both sides of your head and cause mild to moderate pain that feels like pressing or tightening. Worse yet, new daily persistent headaches may not give you much of a break after they appear; they can become constant within three days of the head pain starting. This is basically the headache version of a guest who not only shows up to your home uninvited but also decides they’d like to stay awhile.
Experts are still working to identify the cause of these out-of-nowhere headaches. They do know that they can sometimes cause symptoms of migraines or tension-type headaches, though.
One of the criteria for hemicrania continua is having a persistent headache of at least a moderate level of pain for more than three months, according to the National Institute of Neurological Disorders and Stroke. This pain usually wreaks havoc on the same side of your face and head instead of spreading out. People with hemicrania continua also have at least one of the following symptoms: eye redness or tearing, nasal congestion or a runny nose, a drooping eyelid, narrowed pupils, and a sensation of restlessness, according to the Mayo Clinic. The cause of this head pain still eludes the medical world. (Seeing a pattern here?)
Although the exact source of headaches is largely still puzzling, it’s clear that certain factors raise your risk, including being a woman.
Having one or several of the following risk factors makes it more likely that you’ll wind up with chronic head pain:
Being a woman: The mechanism behind this isn’t totally understood, but it’s thought that hormones play a role, specifically fluctuations in estrogen levels, Amit Sachdev, M.D., an assistant professor and director of the Division of Neuromuscular Medicine at Michigan State University, tells SELF.
Having anxiety or depression: “Patients with depression and anxiety are more likely to have [chronic head pain], and patients with [chronic head pain] are more likely to have depression and anxiety,” Kevin Weber, M.D., a neurologist at The Ohio State University Wexner Medical Center, tells SELF. But doctors aren’t really sure why this is the case. “There is clearly a genetic component to anxiety and depression,” Dr. Sachdev says. “It is possible that genetics has something to do with why some folks get the triad of headache, anxiety, and depression.” But he adds, this is just a guess.
Not sleeping well: Some people can sleep great and still get persistent headaches while others will wind up with headaches after one instance of subpar rest, Dr. Sachdev point out. Still, “poor sleep is clearly a trigger for headaches,” he says.
Snoring: Specifically, tension-type headaches have been associated with sleep apnea, a condition that often causes snoring because you have trouble breathing properly in your sleep, according to the National Institute of Neurological Disorders and Stroke. The link here could be that sleep apnea changes the width of the blood vessels in your brain, which can lead to head pain, Dr. Sachdev says.
Having too much caffeine: Some people who have headaches benefit from daily caffeine use, which may constrict dilated blood vessels that lead to discomfort, while others need to avoid it because it does have the potential to trigger head pain. Even if caffeine doesn’t prompt your original head pain, it may play into rebound headaches that can happen in some people after long-term use of a medication or drug. (Remember, caffeine is a stimulant.)
Taking too much headache medication: This is that rebound headache phenomenon at play again. To keep things in check, ask your doctor how often you’re OK to take your headache medication (and have substances such as caffeine). Although the guidelines depend on the kind of drug, they may have you avoid using over-the-counter painkillers for more than 15 days a month, for example.
Having another chronic pain condition: This could be due to one of two things. One is that if you have a chronic pain condition you might regularly use pain medications that could cause rebound headaches, Dr. Weber explains. The other is that your brain may perceive unpleasant sensations more intensely when you’re already in pain, Dr. Sachdev says. It’s a terrible double whammy.
As soon as you ask yourself if you need a doctor for head pain, it’s time to go see one.
This rule stands whether this is your first experience with severe head pain or if you’re used to specific type of, say, migraines, but are now experiencing strange new symptoms. That’s especially true if your headaches are interfering with your daily life or you have symptoms like blurry vision, fever, neck pain, or weakness, Dr. Sachdev says (these can indicate that something else is going on, like a stroke).
Even if your head pain isn’t too intense, if you’re consistently having two or more headaches a week, you should see a doctor, Medhat Mikhael, M.D., a pain management specialist at MemorialCare Orange Coast Medical Center in Fountain Valley, California, tells SELF. Be prepared to describe your pain to them in as vivid detail as possible, Dr. Mikhael says.
Once you get into your doctor’s office, they will examine you, ask you questions about your symptoms, and possibly order some imaging studies like a CT scan or MRI to rule out other conditions, Dr. Weber says. Your course of treatment depends on the suspected cause after all that investigation. The good news is that there are tons of head pain treatments out there, including prescription nonsteroidal anti-inflammatory drugs to reduce inflammation, triptans (these narrow widened blood vessels and obstruct pain pathways), and tricyclic antidepressants to change your brain chemicals. Even Botox injections may help with the pain, though experts aren’t sure how.
Whatever you do, don’t just assume you have to deal with constant headaches or keep self-treating with OTC medication. “Your headache needs to be well-diagnosed so doctors can find out the source behind it and fix it,” Dr. Mikhael says.