Chronic Headaches

with Michael Mitchell, M.D., neurologist with Columbia St. Mary’s

Last Updated: Sept. 1, 2003

Headaches are a universal malady. From the sudden stab of a migraine to the dull throb of stuffed sinuses, they’re a part of nearly everyone’s life. But for some people headaches can become a frequent, even daily, occurrence.

Here are some tips on the causes and treatment of frequent headache pain as well as information on headache symptoms that may indicate life-threatening conditions.

Michael Mitchell, M.D., Neurologist with Columbia St. Mary's "As varied as neurology is, most of my patients are younger people with chronic headaches. If I can get them focused on the problem and feeling better, it's a rewarding thing."

Signs of rebound headaches
According to Dr. Michael Mitchell, a neurologist with Columbia St. Mary’s, frequent or chronic daily headaches are usually caused by migraines or tension headaches. Often, a headache sufferer who is suddenly reaching for pain relief medications on a daily basis also suffered from migraines in the past.

The term “rebound headaches” refers to headaches brought on by the pain relieving drugs themselves, both over-the-counter and prescription products. “Often these products contain caffeine, a narcotic or butalbital plus caffeine. For sporadic headaches, these work well but when the drug starts wearing off, there is a rebound,” Dr. Mitchell said.

What that occurs, the sufferer usually reaches for another dose of the medication, resulting in another few hours of respite, then a need for another round of medication. “In patients such as these, who have been taking medications for months, or even years, frequent medication can cause these rebounds.

“Even drugs that have revolutionized migraine care, such as Imitrex, can be overused and transform an occasional migraine into daily headaches,” the doctor said.

Usually chronic headache problems develop over time, though the problem can also occur suddenly. The frequent headaches may be accompanied by other symptoms.

“Patients may experience fatigue, restlessness, anxiety or depression, sleep disturbances, problems with memory or concentration. These are all consequences of the medication that is being overused,” the doctor said.

Overcoming this drug tolerance may require some careful balancing. “You need to withdraw the offending drug causing the headaches by placing people on medication to make the headaches less frequent or intense. There are several options,” Dr. Mitchell said. Among these are tricyclic medications (such as amitriptyline), anti-seizure medications, beta blockers, calcium channel blockers, or a mixture of magnesium/riboflavin.

Headache danger signals
Most headaches are benign but not all of them. In some cases the smartest move a headache sufferer can make is to reach for the telephone rather than the aspirin bottle and call a doctor.

“We want a patient to come in for an examination if headaches are of recent onset, or have changed in character. ‘The first or the worst,’ are warning signs.

“Another sign is if headaches begin to be associated with neurological problems such weakness or tingling, if they cause personality change or vision change. Morning or nocturnal headaches are also a warning sign, especially if they are accompanied by vomiting. These symptoms are seen with migraines, but also with brain tumors,” Dr. Mitchell said.

But the most dangerous sign is what Dr. Mitchell termed a “sudden thunderclap headache, one that reaches maximum intensity within a minute.” This is the classic symptom of an aneurysm, and anyone who experiences this type of sudden intense pain should seek medical care immediately.

The headache exam
Physicians will usually take a patient history, then may order a number of tests. The two tests most commonly used to rule out serious conditions are:

• An MRI or CT scan to check for brain tumors, blood clots, aneurysms or fluid buildup in the brain.
• A lumbar puncture to check for infection around the brain or spinal cord. This is used if a patient also has a fever or stiff neck to rule out infections such as West Nile or meningitis.
• Physicians may also order blood tests, EEGs if a patient is also suffering from seizures, or other tests.

Dr. Mitchell stressed that even those undergoing tests rarely have anything seriously wrong. “Most of my patients are just normal healthy people with bad headaches, usually amplified by a pattern of overuse of pain relief medications. Even those who come in with changes in headache patterns usually have nothing seriously wrong. We don’t know why headache patterns change over time. They just do and they should be checked out,” he concluded.

We Have Answers Do you have medical questions or need help finding a doctor? The experts at Columbia St. Mary's and Advanced Healthcare can help. Click here.