The distraction of a headache is something many know well: up to 1 in 20 adults has a headache every day, according to the World Health Organization. Even if you’re not experiencing them daily, constant headaches can make it difficult to get anything done, despite the plethora of pain-relief options out there. So how do you know when it’s time to seek help for your headaches?
If headaches are impacting your life, talk to your doctor.
While there are clinical guidelines for what constitutes frequent and chronic headaches (less than one day a month is infrequent, between one and 14 days a month is frequent, and 15 or more days a month is chronic), there’s a really simple barometer for escalating the issue with your doctor: “If headaches are affecting your life, then it’s something that we definitely need to work on,” says Mike Chen, MD, a doctor at Parsley Health in New York.
So whether your headaches are so bad you have to stay home from work, or they’re mild but preventing you from enjoying your free time, it’s worth bringing them up to your doctor.
And it’s best to avoid trying to diagnose yourself. “When you’re a patient, you only see one of yourself. As a Parsley doctor, I see hundreds of people like you,” Dr. Chen explains. You’ll benefit from having access to that experience and data set.
Not all headaches are the same.
Before your doctor can start narrowing down the cause of your constant headaches, it’s helpful for them to know what type of headaches you’re experiencing. “It’s estimated that tension, migraine, and cluster headaches account for 90 percent of all headaches,” Dr. Chen says. Only your doctor can determine which type of headache you’re having, but it’s useful to understand the hallmarks of each kind so you can better describe your symptoms to your doctor.
Tension headaches usually affect both sides of the head and cause mild to moderate pain. Common sensations include pressing and tightening, but not pulsating pain. The discomfort usually waxes and wanes, and doesn’t usually come along with nausea or vomiting, Dr. Chen adds.
Tension headaches are incredibly common, with an estimated 70 percent of the world population experiencing them occasionally, and 1 to 3 percent experiencing them chronically. Dr. Chen sees chronic tension headaches most often, followed by…
Migraine headaches are classically thought of as being unilateral or one-sided, and the pain is usually pulsating, Dr. Chen says. A telltale sign your headache is a migraine? “The pulsating is generally aggravated by noise and light, and oftentimes you’ll feel nauseous as well.”
But sometimes, it can be difficult to tell the difference between tension and migraine headaches, Dr. Chen notes. And the causes of migraines and other headaches overlap. For these reasons, diagnosis and treatment for these chronic headaches can be one in the same. “Usually, I end up treating both migraine and tension at the same time and seeing what sticks,” he adds.
This kind of headache is thought of as one of the three main types of chronic headaches, but it’s much less common than migraines and tension headaches, Dr. Chen says, affecting fewer than 1 in 1,000 adults. This type of headache comes on suddenly in seconds or minutes, and is usually focused on one side. Commonly, it causes eye tearing and a runny nose on one side.
Interestingly, cluster headaches are much more common in men than in women, affecting 6 men for every 1 woman.
The most common chronic headache causes
At Parsley Health, doctors look for the root cause of your headaches. So while medicine could be part of the treatment plan, the end goal is to try to determine the cause of your chronic headaches and fix it, so you hopefully don’t have to deal with them anymore. Let’s take a look at the most common causes.
1. Stress overload
The people most at risk for constant headaches are those under high emotional or work-related stress, according to Dr. Chen. “Stress is the most common cause for both tension headaches and migraine headaches.”
Stress can cause or worsen headaches through a variety of mechanisms. The stress hormones activated when the body goes into “fight or flight” mode also act on our blood vessels, which can bring on headaches. Emotions like anxiety, worry, and fatigue can also increase muscle tension, which can exacerbate or cause headache pain. This is one of the reasons Parsley makes meditation part of every member’s plan. “It’s definitely been shown to decrease stress,” Dr. Chen adds.
2. Sleep problems
Sleep is the foundation of good health, and too much or too little can trigger headaches. Migraines in particular seem to be impacted by sleep issues, as migraine sufferers are 2 to 8 times more likely to have a sleep disorder, according to the American Migraine Foundation. Getting a solid 7 to 8 hours of sleep can be immensely helpful in lessening the symptoms of chronic headaches, Dr. Chen says.
It’s also worth paying attention to substances that can affect your sleep, like caffeine and alcohol. “I had a patient in his mid-20s dealing with headaches, and his Parsley health coach discovered he was drinking a huge amount of sweet tea and iced coffee every day. So it turned out he was setting himself up for poor sleep and caffeine withdrawal.” Once he stopped drinking those beverages, focused on getting quality sleep, and added in some exercise, he stopped having headaches and was able to stop taking medication for them.
Similarly, alcohol can affect your circadian rhythm and block REM sleep, making falling asleep, staying asleep, and getting good quality sleep more difficult.
3. Musculoskeletal issues
“If you have neck tension or shoulder tension, that sometimes can be a trigger for tension and migraine headaches,” Dr. Chen says. These issues might be relieved by chronic headache treatments like acupuncture, physical therapy, or seeing a chiropractor.
4. Food intolerance and other digestive issues
Headaches are also very commonly caused by gut issues related to food intolerance or sensitivity, Dr. Chen says. “We especially focus on food triggers as possible causes of headaches, particularly foods like gluten, dairy, and eggs.”
“We know from embryology that the same cells that form our gut migrate to form our nervous system,” Dr. Chen explains. “So the mind-gut connection and gut-mind connection are huge.” Your brain can sense physical signals down to your gut neurons, causing them to turn on.” Likewise, digestive symptoms can send signals to your brain that cause headaches.
Often, an elimination diet can reveal underlying sensitivities and intolerances. It may also be worth boosting gut health by taking a proven probiotic supplement and/or eating fermented and prebiotic-rich foods.
5. Nutrient deficiencies
Lacking certain nutrients in your diet can also cause constant headaches, including vitamin B2, riboflavin, vitamin D, and magnesium. Often, supplementing with these vitamins and minerals can help alleviate headaches. “Higher doses of riboflavin and magnesium are actually one of our first line treatments for headaches within functional medicine as a way to see if we can avoid conventional medications.”
6. Hormonal imbalances
Headaches (especially migraines) can be brought on by hormonal changes, particularly during different parts of a woman’s menstrual cycle due to an imbalance between estrogen and progesterone. “For example, too much estrogen, not enough progesterone can trigger migraine headaches. Working to optimize your menstrual cycle through diet, supplements, and other lifestyle adjustments can help.
Putting it all together
So what’s the bottom line here? Making changes to your lifestyle can make all the difference in your chronic headache treatment. While conventional medications like tricyclic antidepressants and pain relievers can certainly help, sometimes getting to the bottom of your headaches is less complicated than you’d think. “I think so often, when you see a doctor, you want fancy treatments,” Dr. Chen says. “But it sometimes, it can be as simple as making sure you’re getting 7 to 8 hours of sleep or making sure you’re not drinking too much alcohol.”