Published 4th August 2022

What to do about a persistent headache

It can be incredibly frustrating to deal with a stubborn headache, whether it won’t go away or it just keeps coming back. 

Persistent headaches can negatively impact your work, social life, and enjoyment of day-to-day activities. 

In this article, we’ll explain some common causes of long-lasting headaches and when to seek urgent medical attention, and we’ll also explore whether your headache might be a symptom of COVID-19. 

When should I be worried?

Long-lasting headaches are common, with about 15% of adults in the United States experiencing migraines or severe headaches each year.

However, you should seek immediate medical attention if you’re experiencing a particularly intense headache or if your headache involves: 

  • loss of vision

  • loss of consciousness

  • uncontrollable vomiting

  • pain lasting longer than 72 hours, with a pain-free period shorter than 4 hours

  • any symptom that is frightening and abnormal for you

If you have a concerning headache alongside an autoimmune, liver, kidney, or heart condition, contact your healthcare provider for advice. 

Causes and treatments

Headaches that spring from different causes require different treatments. 

COVID-19 headaches

Users of the ZOE Health Study app reported headache as one of the most common symptoms of COVID-19. 

The ZOE COVID Study involved over 63,000 individuals who tested positive for COVID-19 between June 2021 and January 2022. During this time, the participants consistently reported their infection status and symptoms, including headache. 

The study showed that about 78% of people with COVID-19 reported headaches when Delta was dominant and 75% when Omicron was dominant. 

COVID-19 headaches tend to: 

  • be moderate to severe in pain

  • last longer than 3 days

  • feel like a pulsing, pressing, or stabbing pain

  • be unresponsive to painkillers 

  • feel painful on both sides of the head 

A multi-center study reported that almost 20% of individuals who experienced headaches during their SARS-CoV-2 infection were still experiencing them at 3 months. After 9 months, 16% of the participants were still experiencing them. 

The scientists also found a link between how severe the headache pain was when people first had COVID-19 and how long they lasted after the infection.

However, this study had a few very important limitations, and further studies are needed to evaluate the possibility of chronic COVID-19-related headaches.

Migraine

Migraine is a complex neurological condition that typically includes intense and recurring headaches. 

The International Headache Society categorize migraines into three primary subtypes: those with an aura, those without an aura, and chronic migraines. 

Aura refers to a period of sensory disturbances usually happening before the headache pain. Chronic migraine is a condition involving frequent headaches that happen on 15 or more days, over 3 or more months, and that includes other symptoms of migraine on 8 or more days per month.

Other symptoms can accompany the intense headache pain, such as:

  • sensitivity to light, sound, or smells

  • nausea and vomiting

  • sensitivity to movement 

Females are three to four times more likely to experience migraines than males. In the U.S., migraines are most common at ages 18–44.

Some ways to manage migraine pain include:

  • taking over-the-counter medications

  • avoiding intense sensory stimuli

  • practicing stress reduction techniques

  • trying aromatherapy

In the long-term, certain lifestyle changes may help reduce the frequency or intensity of migraines.

Rebound headaches 

While painkillers can be a valuable headache treatment, overuse of over-the-counter pain relief medications can cause rebound headaches. Rebound headaches are common in people who regularly experience migraines and tension headaches. 

Rebound headaches are common worldwide, affecting 1–2% of people globally. 

They happen on more than 14 days a month and are typically worse in the morning. People with rebound headaches often report having additional neck pain.

While they tend to be alleviated by taking over-the-counter medication, rebound headaches usually return as soon as the pain relief wears off, creating a vicious cycle.

If you experience rebound headaches, speak to your healthcare provider about ways to manage them. Your doctor may suggest gradually reducing the amount of medication that you’re using. 

It may also be helpful to make some lifestyle changes to alleviate some of the underlying causes of the primary headache. We’ll discuss these further down.

Tension-type headaches

Tension-type headaches (TTH) are headaches that experts believe are associated with tightness in the head muscles. 

TTH can last anywhere from 30 minutes to 7 days. 

The pain is typically:

  • mild to moderate in intensity

  • a tightening or pressing sensation

  • on both sides of the head

In contrast to migraines, TTH do not involve:

  • nausea or vomiting

  • sensitivity to movement 

  • more than one episode of sensitivity to lights or sounds

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About 3% of people worldwide experience TTH every year. TTH are most common at ages 40–49, while females are slightly more likely to experience them across all ages.

The first line of treatment for TTH is over-the-counter medicines, like aspirin. However, if this doesn’t work, your healthcare provider may suggest other medications.

In the long-term, certain medications and biofeedback may help reduce the frequency or intensity of TTH. While lifestyle changes can improve headaches that occur during a migraine, there is little evidence for their effectiveness in TTH specifically.

Cervicogenic headaches

A cervicogenic headache is a headache arising from pain in the upper spine.

The experience feels like a stabbing pain shooting up from one side of your neck. 

The pain may be more severe when you pivot your head sharply to one side. This typically causes a reduced range of movement in the neck. 

Neck injuries, such as whiplash, are often the cause of cervicogenic headaches, but arthritis in the upper spine can also cause them.

The first line of treatment is usually physical therapy. However, manipulative therapy, specific exercise regimens, steroid injections, and — in rare cases — surgery are effective in some cases. 

Hemicrania continua

Hemicrania continua (HC) is a headache condition characterized by a dull, one-sided pain lasting longer than 3 months. Throughout this constant headache, HCs involve recurring episodes of increased pain ranging from moderate to very severe in intensity.

Alongside the headache, symptoms include restlessness or agitation, as well as sensitivity to movement. 

Some symptoms occur only on the same side as the headache pain, such as:

  • a bloodshot or teary eye

  • nasal congestion or runny nose

  • a swollen or drooping eyelid

  • facial sweating

  • a constricted pupil

Scientists conservatively estimate that 1% of headache cases are HCs. 

The average age of someone with HC is 30, with cases most prevalent in young adults in their 20s to 30s. HC is also twice as common in females than in males.

If you suspect your headache is HC, speak with your healthcare provider to decide the next steps. Indomethacin, a non-steroidal anti-inflammatory drug, is used as the first line of treatment for HC. 

If indomethacin is not an option, your healthcare provider may explore alternative medications or other treatments, like botox injections.

Dehydration

While it may seem like simple advice, it can be easy to forget to drink enough water. Being dehydrated can be enough to cause a headache and can make an existing headache condition worse. 

If this is the problem, there’s a solid solution — drink more water!

Some tips to help boost your daily water intake include:

  • starting your day with a large glass of water 

  • drinking water with each meal

  • keeping a water bottle accessible

  • using a straw to make it easier to drink 

  • flavoring your water with herbs, fruits, or vegetables

General treatment and long-term prevention

Long-lasting headaches can be frustrating, but making small changes to your lifestyle may help

You might like to try: 

  • reducing stress levels through meditation and mindfulness

  • enjoying gentle forms of exercise and regular movement

  • staying well-hydrated, especially in the heat

  • looking at your diet and changing what you eat

  • limiting potentially triggering foods like caffeine and alcohol

  • ensuring you allow a 7–8-hour period for restful sleep each night

  • using massage therapy to reduce tension in your neck and shoulders

Summary

Experiencing a headache that won’t go away can be concerning. 

While most headaches respond well to treatment and are rarely serious, you should seek urgent medical attention if you’re experiencing frightening or abnormal symptoms.

Migraines, rebound headaches, tension-type headaches, cervicogenic headaches, and hemicrania continua are all headache conditions with different presentations and treatments.

Over-the-counter medications can often be helpful for headache pain. However, depending on the severity of your symptoms, you may need to speak with a healthcare provider. 

They can work with you to decide the best treatment option for managing your headache.

Sources

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Dehydration and headache. Current Pain and Headache Reports. (2021). https://pubmed.ncbi.nlm.nih.gov/34268642/

Food as trigger and aggravating factor of migraine. Neurological Sciences. (2012). https://pubmed.ncbi.nlm.nih.gov/22644176/

Giving researchers a headache - sex and gender differences in migraine. Frontiers in Neurology. (2020). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7642465/

Headache? When to seek medical attention. (2010). https://headaches.org/headache-when-to-seek-medical-attention/

Hemicrania continua. StatPearls. (2022). https://www.ncbi.nlm.nih.gov/books/NBK557568/

Lifestyle modifications for migraine management. Frontiers in Neurology. (2022). https://pubmed.ncbi.nlm.nih.gov/35370920/

Medication-overuse headache. Practical Neurology. (2019). https://pubmed.ncbi.nlm.nih.gov/31273078/ 

Medication-overuse headache. StatPearls. (2022). https://www.ncbi.nlm.nih.gov/books/NBK538150/

Migraine headache. StatPearls. (2022). https://pubmed.ncbi.nlm.nih.gov/32809622/

Post-COVID-19 persistent headache: a multicentric 9-months follow-up study of 905 patients. Cephalalgia. (2022). https://pubmed.ncbi.nlm.nih.gov/35166156/ 

SEEDS for success: lifestyle management in migraine. Cleveland Clinic Journal of Medicine. (2019). https://pubmed.ncbi.nlm.nih.gov/31710587/

Symptom prevalence, duration, and risk of hospital admission in individuals infected with SARS-CoV-2 during periods of omnicron and delta variant dominance: a prospective observational study from the ZOE COVID Study. The Lancet. (2022). https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00327-0/fulltext 

Tension-type headache. BMJ. (2008). https://pubmed.ncbi.nlm.nih.gov/18187725/

The presence of headache at onset in SARS-CoV-2 infection is associated with long-term post-COVID headache and fatigue: a case-control study. Cephalalgia. (2021). https://pubmed.ncbi.nlm.nih.gov/34134526/ 

The prevalence and impact of migraine and severe headache in the United States: updated age, sex, and socioeconomic-specific estimates from government health surveys. Headache. (2021). https://pubmed.ncbi.nlm.nih.gov/33349955/ 

Treatment of medication overuse headache - a review. Acta Neurologica Scandinavica. (2019). https://pubmed.ncbi.nlm.nih.gov/30710346/

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