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PostSubject: Chronic daily headaches   Chronic daily headaches EmptyThu Jan 20, 2011 3:06 pm

Chronic daily headaches
Most people have headaches from time to time. But if you have a headache
more days than not, you may be experiencing a variety of head pain
known as chronic daily headaches.

The incessant nature of chronic daily headaches makes them among the
most disabling headaches. Aggressive initial treatment and steady,
long-term management may reduce pain and lead to fewer chronic daily


By definition, chronic daily headaches must occur 15 days or more a
month, for at least three months. And to be considered true (primary)
chronic daily headaches, they must also not be the result of another

Chronic daily headaches are classified by how long they last — more than
four hours or less than four hours. The longer lasting headaches are
more common and addressed here. They're divided into four types:

* Chronic migraine
* Chronic tension-type headache
* New daily persistent headache
* Hemicrania continua

Chronic migraine
These headaches evolve from episodic migraine without aura. To be
diagnosed with chronic migraine, you must have headaches — migraine,
tension-type or both — 15 days or more a month, for at least three
months. In addition, on eight or more days a month for at least three
months, you must experience the following symptoms.

Your headaches have at least two of the following characteristics:

* Affect only one side of your head
* Cause a pulsating pain
* Cause moderate to severe pain
* Are aggravated by routine physical activity

And they cause at least one of the following:

* Nausea, vomiting or both
* Sensitivity to light and sound

Alternatively, if your headaches respond to triptan medications or ergot
medications taken in anticipation of these symptoms — on eight or more
days a month for at least three months — they're also considered chronic

Chronic tension-type headache
These headaches evolve from episodic tension-type headaches. They may last hours or be constant.

Chronic tension-type headaches have at least two of the following characteristics:

* Hurt on both sides of your head
* Cause mild to moderate pain
* Cause pain that feels pressing or tightening, but not pulsating
* Aren't aggravated by routine physical activity

In addition, they cause no more than one of the following:

* Sensitivity to light or sound
* Nausea (mild only)

New daily persistent headache
These headaches become constant within a few days of the moment you have your first headache.

New daily persistent headaches have at least two of the following characteristics:

* Hurt on both sides of your head
* Cause pain that feels like pressing or tightening, but not pulsating
* Cause mild to moderate pain
* Aren't aggravated by routine physical activity

In addition, they cause no more than one of the following:

* Sensitivity to light or sound
* Nausea (mild only)

Hemicrania continua
These headaches cause pain on only one side of your head that doesn't shift sides. They also:

* Are daily and continuous with no pain-free periods
* Cause moderate pain but with spikes of severe pain
* Respond to the prescription pain reliever indomethacin (Indocin)
* May sometimes become severe with development of migraine- like symptoms

In addition, hemicrania continua headaches cause at least one of the following:

* Tearing or redness of the eye on the affected side
* Nasal congestion or runny nose
* Drooping of the eyelid or constriction of the pupil

When to see a doctor
Occasional headaches are common. But it's important to take headaches seriously. Consult your doctor if:

* You usually have two or more headaches a week
* You take a pain reliever for your headaches every day or almost every day
* You need more than the recommended dose of over-the-counter pain remedies to relieve your headaches
* Your headache pattern changes
* Your headaches are getting worse

Seek prompt medical care if your headache:

* Is sudden and severe
* Accompanies a fever, stiff neck, confusion, seizure, double vision, weakness, numbness or difficulty speaking
* Follows a head injury
* Gets worse despite rest and pain medication


The causes of many chronic daily headaches aren't well understood. True
(primary) chronic daily headaches don't have an identifiable underlying
cause. They may occur if:

* You develop a heightened response to pain signals
* The part of your brain that suppresses pain signals isn't working properly

Other frequent headaches may be caused by various underlying diseases or conditions, including:

* Inflammation or other problems with the blood vessels in and around the brain, including stroke
* Infections, such as meningitis
* Intracranial pressure that's either too high or too low
* Brain tumor
* Traumatic brain injury

Many people who have frequent headaches are actually experiencing a
rebound effect from taking pain medication too often. If you're taking
pain medications — even over-the-counter analgesics — more than three
days a week, you're at risk of developing rebound headaches.

Risk factors

Various factors may increase the risk of developing frequent headaches, including:

* Anxiety
* Depression
* Sleep disturbances
* Obesity
* Snoring
* Overuse of caffeine
* Overuse of pain medication
* Regular use of physical postures that put a strain on your head or neck


If you have chronic daily headaches, you're also more likely to
experience depression, anxiety, sleep disturbances, and other
psychological and physical problems.

Preparing for your appointment

You're likely to start by first seeing your family doctor or a general
practitioner. However, in some cases when you call to set up an
appointment, you may be referred immediately to a headache specialist.

Because appointments can be brief, and because there's often a lot of
ground to cover, it's a good idea to be well prepared for your
appointment. Here's some information to help you get ready for your
appointment, and what to expect from your doctor.

What you can do

* Be aware of any pre-appointment restrictions. At the time you make
the appointment, be sure to ask if there's anything you need to do in
advance, such as restrict your diet.
* Keep a headache journal, which should include when each headache
occurred, how long it lasted, how intense it was, what you were doing
immediately before the headache started, and anything else that was
notable about the headache.
* Write down any symptoms you're experiencing, including any that
may seem unrelated to the reason for which you scheduled the
* Write down key personal information, including any major stresses or recent life changes.
* Make a list of all medications, as well as any vitamins or supplements, that you're taking.
* Take a family member or friend along, if possible. Sometimes it
can be difficult to soak up all the information provided to you during
an appointment. Someone who accompanies you may remember something that
you missed or forgot.
* Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions
will help you make the most of your time together. List your questions
from most important to least important in case time runs out. For
chronic headaches, some basic questions to ask your doctor include:

* What is likely causing my headaches?
* Are there other possible causes for my headaches?
* What kinds of tests do I need?
* Is my condition likely temporary or chronic?
* What is the best course of action?
* What are the alternatives to the primary approach that you're suggesting?
* I have these other health conditions. How can I best manage them together?
* Are there any restrictions that I need to follow?
* Should I see a specialist? What will that cost, and will my insurance cover seeing a specialist?
* Is there a generic alternative to the medicine you're prescribing me?
* Are there any brochures or other printed materials that I can take home with me? What Web sites do you recommend?

In addition to the questions that you've prepared to ask your doctor,
don't hesitate to ask questions during your appointment at any time that
you don't understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to
answer them may reserve time to go over any points you want to spend
more time on. Your doctor may ask:

* When did you first begin experiencing headaches?
* Have your headaches been continuous or occasional?
* How severe are your headaches?
* What, if anything, seems to improve your headaches?
* What, if anything, appears to worsen your headaches?

What you can do in the meantime
There are some things you can do before seeing your doctor to try to improve your headache pain:

* Avoid activities that you know make your headaches worse.
* Try over-the-counter nonsteroidal anti-inflammatory drugs — such
as naproxen (Aleve) and ibuprofen (Advil, Motrin, others). Don't take
these more than 15 days a month, because that may make your headaches

Tests and diagnosis

Your doctor will probably do a physical exam to check for signs of
illness, infection or neurological problems. If the cause of your
headaches remains uncertain, you may need blood or urine tests to
identify any underlying medical conditions. Sometimes imaging studies —
such as an X-ray, CT scan or MRI scan — are recommended.

Treatments and drugs

Treatment for any underlying diseases or conditions often stops frequent
headaches. When no underlying diseases or conditions are present,
treatment focuses on preventing the pain before it starts.

Specific prevention strategies vary, depending on which type of headache
you have and whether medication overuse is contributing to these
headaches. If you're taking pain relievers more than two days a week,
the first step in treatment may be to stop using these drugs. 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), may be helpful, for treatment of depression and anxiety, too.
* 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). Sometimes beta
blockers are prescribed in combination with antidepressants, and this
combination is sometimes more effective than either medication on its
* Anti-seizure medications. Some anti-seizure drugs seem to prevent
migraines. These medications may be used to prevent chronic daily
headaches as well. Options may include gabapentin (Neurontin) and
topiramate (Topamax).
* NSAIDs. Nonsteroidal anti-inflammatory drugs — such as naproxen
(Anaprox, Naprelan) — may be helpful, especially if you're going through
withdrawal from other pain relievers. They may also be used
periodically when the headache is more severe.
* Others. Injections of a local anesthetic around a nerve or
injections of a numbing agent and corticosteroid at the point of pain
(trigger point injections) are sometimes recommended for chronic daily
headaches. Although their role needs to be better defined, botulinum
toxin type A (Botox) injections provide relief for some people as well.

Unfortunately, some chronic daily headaches remain resistant to all medications.

Alternative medicine

For many people, complementary or alternative therapies offer welcome
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. Studies have
shown that acupuncture helps reduce the frequency and intensity of
chronic headaches.
* Biofeedback. In biofeedback, you can learn to control headaches by
becoming more aware of and then changing certain bodily responses such
as muscle tension, heart rate and skin temperature.
* Meditation. Practicing meditation can help you relax physically
and remain calm mentally. The practice creates a deeply restful state in
which your breathing slows and your muscles relax — which can help you
manage pain and reduce stress.
* 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,
tender 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 prevent migraines by
correcting tiny deficiencies in brain cells. 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. Magnesium taken intravenously seems to
help some people during an acute headache, particularly people with
magnesium deficiencies. Ask your doctor if these treatments are right
for you. Don't use feverfew or butterbur if you're pregnant.
* Chiropractic care. Spinal manipulation can effectively treat some
types of pain, though it's not been proved to be effective for
* 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
investigational and has shown some good results but is not a standard

If you'd like to try a complementary or alternative therapy, discuss the risks and benefits with your doctor.

Coping and support

Chronic daily headaches can interfere with your job, your relationships
and your quality of life. But you can cope with the challenges.

* Take control. Commit yourself to living a full, satisfying life.
Work with your doctor to develop a treatment plan that works for you.
Take good care of yourself. Do things that lift your spirits. Set aside
time for your loved ones — and yourself — every day.
* Seek understanding. Don't expect friends and loved ones to
instinctively know what's best for you. Ask for what you need, whether
it's time alone or less attention focused on your headaches.
* Check out support groups. You may find it useful to talk to other
people who experience painful headaches. Try finding a support group in
your area to learn how other people cope with their headache pain and
* Consider counseling. A counselor or therapist offers much needed
support and can help you manage stress. Your therapist can also help you
understand the psychological effects of your headache pain.


Taking good care of yourself can help prevent chronic daily headaches.

* Avoid headache triggers. If you're not sure what triggers your
headaches, keep a headache diary. Include details about every headache.
When did it start? What were you doing at the time? What did you eat
that day? How did you sleep the night before? What was your stress
level? How long did the headache last? What, if anything, provided
relief? Eventually, you may begin to see a pattern — and be able to take
steps to prevent future headaches.
* Avoid medication overuse. Taking headache medications, including
over-the-counter medications, more than twice a week can actually
increase the severity and frequency of your headaches. If you are taking
medication too often, it is important to consult your doctor about how
best to wean yourself off the medication because there can be serious
side effects if done improperly.
* Get enough sleep. The average adult needs six to eight hours of
sleep a night. It's best to go to bed and wake up at regular times, as
* Don't skip meals. Start your day with a healthy breakfast. Eat
lunch and dinner at about the same time every day. Avoid any food or
drinks, such as those containing caffeine, that seem to trigger
* Exercise regularly. Regular physical activity can improve your
physical and mental well-being. Exercise also helps reduce stress. With
your doctor's OK, choose activities you enjoy — such as walking,
swimming or cycling. To avoid injury, start slowly.
* Reduce stress. Stress is the most common trigger of chronic
headaches. Get organized. Simplify your schedule. Plan ahead. Stay
positive. Most headaches caused by stress end when the period of stress
is over.
* Relax. Try yoga, meditation or relaxation exercises. Set aside
time to slow down. Listen to music, read a book or take a hot bath.
* Reduce caffeine. While some headache medications include caffeine
because it can be beneficial in reducing headache pain, it can also
aggravate headaches. Try to minimize, or better yet, eliminate caffeine
from your diet.

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