Treatment for an underlying condition often stops frequent headaches. When no other condition is discerned, treatment focuses on preventing pain.
Prevention strategies vary, depending on the type of headache you have and whether medication overuse is contributing to these headaches. If you're taking pain relievers more than three days a week, the first step may be to wean yourself off these drugs with your doctor's guidance.
When you're ready to begin preventive therapy, your doctor may recommend:
- Antidepressants. Tricyclic antidepressants — such as nortriptyline (Pamelor) — can be used to treat chronic headaches. These medications can also help treat the depression, anxiety and sleep disturbances that often accompany chronic daily headaches.
Other antidepressants, such as the selective serotonin reuptake inhibitor (SSRI) fluoxetine (Prozac, Sarafem, others), may help in treating depression and anxiety, but have not been shown to be more effective than placebo for headaches.
- Beta blockers. These drugs, commonly used to treat high blood pressure, are also a mainstay for preventing episodic migraines. Some beta blockers include atenolol (Tenormin), metoprolol (Lopressor, Toprol-XL) and propranolol (Inderal, Innopran XL).
- Anti-seizure medications. Some anti-seizure drugs seem to prevent migraines and may be used to prevent chronic daily headaches, as well. Options include topiramate (Topamax, Qudexy XR, others), divalproex sodium (Depakote) and gabapentin (Neurontin, Gralise).
- NSAIDs. Prescription nonsteroidal anti-inflammatory drugs — such as naproxen sodium (Anaprox, Naprelan) — may be helpful, especially if you're withdrawing from other pain relievers. They may also be used periodically when the headache is more severe.
- Botulinum toxin. OnabotulinumtoxinA (Botox) injections provide relief for some people and may be a viable option for people who don't tolerate daily medication well.
- For many people, complementary or alternative therapies offer relief from headache pain. It's important to be cautious, however. Not all complementary or alternative therapies have been studied as headache treatments, and others need further research.
- Acupuncture. This ancient technique uses hair-thin needles inserted into several areas of your skin at defined points. While the results are mixed, some studies have shown that acupuncture helps reduce the frequency and intensity of chronic headaches.
- Biofeedback. You might be able to control headaches by becoming more aware of and then changing certain bodily responses, such as muscle tension, heart rate and skin temperature.
- Massage. Massage can reduce stress, relieve pain and promote relaxation. Although its value as a headache treatment hasn't been determined, massage may be particularly helpful if you have tight muscles in the back of your head, neck and shoulders.
- Herbs, vitamins and minerals. Some evidence exists that the herbs feverfew and butterbur may prevent migraines or reduce their severity. A high dose of riboflavin (vitamin B-2) also may reduce migraine headaches.
Coenzyme Q10 supplements may be helpful in some individuals. And oral magnesium sulfate supplements may reduce the frequency of headaches in some people, although studies don't all agree. Ask your doctor if these treatments are right for you. Don't use riboflavin (vitamin B-2), feverfew or butterbur if you're pregnant.
- Electrical stimulation of the occipital nerve. A small battery-powered electrode is surgically implanted near the occipital nerve, which is at the base of your neck. The electrode sends continuous energy pulses to the nerve to ease pain. This approach is considered investigational.
- Before trying complementary or alternative therapy, discuss the risks and benefits with your doctor.
Unfortunately, some chronic daily headaches remain resistant to all medications.