Chronic Daily Headache Treatment

In the case of secondary CDH, the primary goal is to treat the underlying condition causing your headaches—this will, in most cases, stop or improve them. When no underlying cause for CDH is found, treatment³³ in the form of medication is aimed at pain prevention and management.

Some medications commonly used to manage and prevent CDH pain include:

• Antidepressants: Tricyclic antidepressants, such as amitriptyline (generic Elavil), have proven successful in treating chronic headaches. One additional benefit to these medications is that they can help treat the emotional issues that can accompany CDH, including depression, anxiety, and sleep disturbances.
• Antihypertensives: Generally used to treat high blood pressure (hypertension), antihypertensives, such as propranolol (generic Inderal, Innopran XL), are highly effective in preventing episodic migraines. Another antihypertensive medication (specifically, a calcium channel blocker) called verapamil (generic Verelan, Verelan PM, Calan SR) is the preventive agent of choice for chronic cluster headaches.
• Anti-seizure medications: Certain anti-seizure medications, including gabapentin (generic Neurontin, Gralise) topiramate (generic Topamax, Qudexy XR), and divalproex sodium (generic Depakote), seem to prevent migraines and may also help prevent chronic daily headaches.
• Botulinum toxin: Patients who don’t tolerate daily medication well may benefit from onabotulinumtoxinA (generic Botox) injections. This option is most frequently used for patients whose headaches have features of chronic migraine.

Additionally, certain forms of CDH are responsive to certain medications: hemicrania continua, for example, is characterized by³⁴ its positive response to indomethacin.

While healthcare providers generally prefer to use just one medication to treat CDH, they may prescribe multiple medications if you don’t respond well enough to just one. Ultimately, the approach taken to preventing and managing your pain will depend on the type of headache you have, its underlying cause, and what treatment(s) work best for you in particular.

Medication for chronic daily headache

Your provider may prescribe the following medications for chronic daily headache:

Chronic daily headache prevention

It may not be entirely possible to prevent frequent headaches from progressing to CDH. Some healthy lifestyle choices³⁵, however, may help decrease or manage the frequency or severity of your headaches, including:

• Avoiding headache triggers: Keeping a log of your headaches that includes details like when it started and what you were doing at the time can help you identify what foods, activities, or circumstances contribute to your headaches. By identifying these triggers, you’ll get a better idea of which ones to avoid.
• Getting plenty of sleep: A lack of sleep can contribute to more frequent headaches. Aim to get the recommended 7–8 hours of sleep each night. Additionally, let your healthcare provider know if you snore, as snoring can contribute to chronic headaches.
• Eating a healthy, consistent diet: Hunger can also cause headaches. Eating healthy meals at roughly the same time each day may help prevent hunger-induced attacks.
• Exercising regularly: High stress levels can increase your risk of developing CDH. Regular exercise can help decrease stress and improve your physical and mental well-being. It’s important that you talk to your healthcare provider before beginning a new exercise regimen, however, as some forms of CDH (such as NDPH) may be worsened by physical activity.
• Reducing or eliminating caffeine: Somewhat paradoxically, caffeine can both cause headaches and help treat them (some migraine medications contain caffeine). Discuss whether you should consider reducing your caffeine consumption with your healthcare provider.