Alimran Clinic Neurosurgery & Pain Medicine · Basra
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Chronic and daily headache

Tension-type, migraine or medication-overuse headache on 15+ days a month. Treatment steps up from lifestyle changes to preventive drugs and procedures.

Pathway
Pain — interventional
Reviewed by
Hussein Imran Mousa, consultant neurosurgeon
Reading time
2 min read
Last reviewed
March 2021

At a glance

What it is

Headache occurring 15+ days per month for at least 3 months. May be tension-type (mild, pressing), migraine (moderate–severe, pulsating, often one-sided), or medication-overuse related.

Typical signs

Daily or near-daily headache, often in morning, occasionally with nausea or light sensitivity, often accompanied by neck stiffness or jaw clenching.

How we treat it

First: identify and discontinue medication overuse. Preventive medication (beta-blockers, calcium-channel blockers, anticonvulsants). Botulinum toxin for chronic migraine. Interventional procedures (nerve blocks, occipital nerve stimulation) if medical therapy fails.

What chronic headache is

Chronic daily headache is defined as headache occurring ≥15 days per month for ≥3 months. It includes chronic tension-type headache, chronic migraine, and new daily persistent headache. In many patients, medication overuse (analgesics, triptans, opioids) perpetuates the headache cycle.

What we see in clinic

4%

Of the global population suffers chronic daily headache

1–2%

Have medication-overuse headache (MOH) as the underlying cause

50–60%

Improve with migraine prevention therapy alone

Key facts

01 Medication-overuse headache develops after >10 days per month of opioids, >15 days of triptans, or >15 days of simple analgesics.
02 Discontinuation of overused medication triggers temporary worsening before improvement (rebound headache).
03 Botulinum toxin is approved for chronic migraine (≥4 migraine days per month) and is given as fixed-dose sets every 12 weeks.

How it is treated

Identify and eliminate triggers and medication overuse. Escalate preventive therapy. Interventional options for refractory cases.

Medication discontinuation

Overuse-related headache

  • Gradual tapering or abrupt cessation depending on drug
  • Expect 4–10 weeks of worsening (rebound) before improvement
  • Inpatient detoxification for severe cases

Preventive medication

First-line for all chronic headache

  • Beta-blockers (propranolol, timolol)
  • Calcium-channel blockers (verapamil, diltiazem)
  • Anticonvulsants (topiramate, valproate)
  • Tricyclic antidepressants (amitriptyline)

Botulinum toxin

Chronic migraine (≥4 migraine days per month)

  • Fixed-dose injections into frontalis, temporalis, occipitalis, neck and shoulder musculature
  • Effect develops over 2 weeks, lasts ~12 weeks
  • Repeat injections every 12 weeks

Interventional procedures

Refractory chronic migraine or tension-type

  • Occipital nerve block or stimulation
  • Greater occipital nerve blocks with steroid
  • Sphenopalatine ganglion blocks for cluster-like or hemicrania continua patterns

Related reading

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Book a consultation

The secretary schedules first appointments during clinic hours; please have prior imaging, operative notes and a current medication list available at the time of the call.

+964-780-1926-801 +964-770-6774-773

This page provides general information about chronic and daily headache and is not a substitute for individual medical assessment. If your symptoms are severe or worsening, contact a clinician promptly.