Medical News Today: What causes a persistent headache?

When a headache lasts for a long time or does not go away after taking medication for it, daily tasks can become difficult or even impossible. However, most lingering headaches will clear up eventually and are not serious.

Headaches are common neurological conditions. In fact, the National Institute of Neurological Disorders and Stroke estimate that nearly 90% of adults will experience a headache at some point in their life.

Headache pain can range from mild to severe and may last for several hours. Although resting and taking over-the-counter (OTC) pain relievers can treat most headaches, some people experience headaches that last for longer than a day.

In this article, we discuss what causes headaches that do not go away, when to see a doctor, and how to get relief.

Causes

Migraine, head injuries, and medication misuse can cause head pain that lasts for several hours or days.

Types of lingering headache can include:

Intractable migraine

a woman with a headache that won't go away
If a person has a persistent headache, they may be experiencing intractable migraine.

Migraine is a type of headache.

Intractable migraine, also known as status migrainosus, is a severe migraine headache that lasts for longer than 72 hours.

The defining characteristic of this type of migraine is its duration. Intractable migraine causes the same symptoms of a typical migraine, but the pain does not improve with standard migraine treatment.

Migraine episodes usually follow a predictable pattern. People can experience prodromes, or auras — which can manifest as visual, physical, auditory symptoms — before the onset of an intense, throbbing headache on one or both sides of the head.

Other symptoms of migraine include:

  • sensitivity to light and sound
  • nausea and vomiting
  • fatigue
  • dizziness
  • changes in mood or behavior
  • confusion

Typical migraine treatments, such as sleep and medication, may not be able to stop an episode of intractable migraine.

Learn how to tell the difference between headache and migraine here.

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Rebound headaches

People who regularly take OTC or prescription pain relief drugs for their headaches can develop medication overuse headaches, otherwise known as rebound headaches.

Rebound headaches tend to occur on a recurring basis. The International Headache Society (IHS) describe a rebound headache as one that occurs on 15 or more days per month in people with a preexisting primary headache disorder and a history of medication overuse.

The symptoms vary from person to person, but they usually follow the same pattern as the preexisting primary headache.

Rebound headaches usually develop in the morning, after waking. Although pain relievers can reduce headache pain, the relief is temporary. It often returns once the medication wears off.

Cervicogenic headaches

Cervicogenic headaches are secondary headaches that result from structural problems in the head, neck, and spine.

These structural issues may be due to:

Typically, people with cervicogenic headaches experience pain that begins in the neck and back of the head and spreads to the front of the head.

Cervicogenic headaches can worsen over time, potentially resulting in damage to the central nervous system.

Some cervicogenic headaches recur regularly, while others linger until a person receives treatment.

Head injury

A traumatic brain injury (TBI), or concussion, can lead to many long term complications, such as the development of new or worsening headaches.

TBIs usually develop after a person sustains a blunt force or penetrating injury to the head. This can occur from:

  • sports injuries
  • falls
  • motor vehicle accidents
  • gunshot wounds

Persistent headaches are among the most common symptoms following a mild TBI, according to a recent article in the journal NeuroRehabilitation.

Moderate or severe TBIs can cause lingering headaches that do not go away or worsen over time.

Additional TBI symptoms may include:

  • enlargement of the pupil in one or both eyes
  • nausea or vomiting
  • slurred speech
  • numbness or tingling in the arms or legs
  • dizziness or loss of coordination
  • behavior or personality changes
  • changes in mental status, such as confusion or memory loss
  • temporary or prolonged loss of consciousness
  • tinnitus, or ringing in the ears
  • sensitivity to light or sound

People should seek immediate medical care if they experience a head injury, even if they do not notice any symptoms right away.

Stroke

Stoke is a serious neurological condition that results from a sudden interruption in blood flow to the brain, such as blood clots or a ruptured blood vessel.

Up to 23% of people develop a persistent headache following a stroke.

Post-stroke headaches often develop in the eyes or on the side of the head where the stroke occurred.

According to the IHS, people can experience headaches that persist for longer than 3 months after recovering from a stroke.


When to see a doctor

woman in doctors office
A person should talk to their doctor if they experience headache “red flags.”

People may want to contact their doctor if they experience the same type of headache many times in 1 month, or if their headaches last for longer than a day.

See a doctor for a headache that never goes away, and for a constant headache that keeps occurring in the same area of the head.

People should seek immediate medical attention if they experience the following:

  • a sudden, severe headache
  • a headache accompanied by neck stiffness
  • a migraine headache that has persisted for several days
  • the onset of new symptoms, such as vision loss, confusion, or fever

The American Migraine Foundation provide guidelines on headache “red flags,” which indicate when a person should see a doctor.

Long term treatments

People can use a combination of medical treatments and lifestyle changes to treat a lingering headache. Some potential treatment options are as follows:

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Medication

A wide variety of OTC and prescription medications can help reduce headache symptoms.

People should only take medication as indicated by the manufacturer or a doctor. Overusing mediation, even OTC pain relievers, can cause rebound headaches.

Common types of medication to treat or prevent lingering headaches include:

  • OTC treatments, such as acetaminophen or Excedrin
  • nonsteroidal anti-inflammatory drugs, such as aspirin or ibuprofen
  • prescription migraine medications, such as triptans, ergotamine, beta-blockers, or calcitonin gene-related peptide antagonists
  • antiseizure drugs, such as topiramate (Topamax) or gabapentin (Neurontin)
  • antidepressants, such as tricyclics antidepressants (TCAs) or selective serotonin reuptake inhibitors (SSRIs)

Botulinum toxin, or Botox, injections offer a safe and effective treatment for people who have chronic migraine headaches that do not respond to traditional medication.

Although most studies used 12-week treatment intervals, the effects of this treatment vary from person to person.

Cognitive behavioral therapy

Cognitive behavioral therapy is a form of psychotherapy that focuses on addressing behaviors and thoughts that may negatively impact a person’s mental and physical health.

With the help of a trained mental health practitioner, people can develop effective strategies to manage their symptoms and prevent future headaches.

Biofeedback

This mind-body technique uses electrical sensors to monitor brain waves, body temperature, heart rate, and muscle tension.

Using the information gained from one or more biofeedback session, people can gain a greater awareness of how their body responds to various things.

For example, a person might learn that the muscles in the head and neck tighten in response to stress, which may contribute to their headaches.

Over time, people can learn to control their physical responses to reduce the intensity or duration of their headache. Some people may even be able to prevent headaches altogether.

Lifestyle changes

a man jogging in the woods
Regular exercise may help prevent headaches.

Factors such as sleep deprivation, caffeine or alcohol consumption, and dehydration can cause frequent headaches. Smoking tobacco can also cause headaches.

A doctor might suggest making the following lifestyle changes to help a person manage their symptoms and prevent headaches in the future:

  • getting enough sleep
  • limiting caffeine intake
  • drinking plenty of water
  • quitting smoking, or not starting
  • exercising regularly
  • lowering stress


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Summary

A lingering headache that lasts for several hours or days can be debilitating and significantly reduce a person’s ability to function.

People who have a headache that does not respond to typical treatment methods, such as resting and taking OTC pain relievers, may want to consider discussing other treatment options with their doctor.

A variety of medical treatments and lifestyle changes can help people manage their symptoms and prevent headaches in the future.

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