When a Headache Won’t Go Away

Long-lasting headaches and migraine usually aren’t life-threatening, but they can certainly interfere with your quality of life. Here’s how to cope and prevent head pain.

Tension headaches — the most common type of headache — can be as brief as 30 minutes or a few hours, but some last as long as a week, according to the Mayo Clinic.

Meanwhile, the headache portion of migraine — a neurological disease that causes debilitating head pain along with other symptoms — usually lasts from four hours to three days, according to the American Migraine Foundation.

“Typically, headaches that are longer than a day and disabling are migraine,” says the headache expert Peter Goadsby, MBBS, MD, PhD, a professor of neurology at the David Geffen School of Medicine at the University of California in Los Angeles. “The median duration for migraine is about a day.”

To understand why your persistent headache won’t go away, it helps to identify the type of headache you have, and what may be triggering it.

Causes of Tension Headache

A tension-type headache typically features mild to moderate pain that feels like a tight band around the head, per the Mayo Clinic.

The causes of these headaches is not totally understood, but researchers believe that people who experience them may have a heightened sensitivity to pain. Tension-type headaches are most commonly triggered by stress.

There are two types of tension-type headaches, and they have different durations.

Episodic tension-type headaches Episodic tension-type headaches can last from 30 minutes to a week, and occur less than 15 days a month for at least three months.

Chronic tension-type headaches Chronic tension-type headaches last hours, may be continuous, and occur 15 or more days a month for at least three months.

Causes of Migraine Headache

In addition to severe throbbing head pain, migraine is often accompanied by nausea, vomiting, and extreme sensitivity to light and sound, according to the Mayo Clinic.

Doctors don’t fully understand the causes of migraine, but genetics and environmental factors appear to be involved, per the Mayo Clinic. Changes in the brain stem and how it interacts with the trigeminal nerve, a major pain pathway, might play a role in causing migraine. Imbalances in certain brain chemicals, including the neurotransmitter serotonin, may also be involved.

There are several risk factors for migraine, including genetics (having a first-degree relative with migraine), age (migraine tends to peak during your thirties), sex (being female), and hormonal changes, especially fluctuations in estrogen.

According to the American Migraine Foundation, the most common migraine triggers include:

Stress
Changes in sleep schedule
Changes in hormone levels, particularly in women
Caffeine and alcohol
Weather changes
Diet, particularly foods that contain histamine and MSG, chocolate, cheese and other dairy products, artificial sweeteners (such as aspartame), caffeine, cured meats, and anything with a strong odor
Dehydration
Light, including natural light and fluorescent or flickering bulbs
Odors
Medication overuse. If you take acute medication prescribed by your doctor more than 10 days per month, it can actually cause more migraine attacks, which is known as medication overuse headache (MOH) or rebound headache.
Depression and anxiety. While doctors don’t completely understand the connection, they think there might be a genetic reason why depression and anxiety seem to be linked to migraine, according to the American Migraine Foundation.

When Severe Headache May Be an Emergency

Although having a long headache may be tiring and frustrating, it’s likely not serious, says Dr. Goadsby. “Having an attack that’s longer than a day doesn’t necessarily mean anything dreadful,” he says.

Occasionally, headaches and migraine may indicate a serious medical condition, such as a brain tumor, aneurysm, or stroke, notes the Mayo Clinic. Seek immediate medical care if you have any of these signs or symptoms:

Abrupt, severe headache (in migraine, it may be like a thunderclap)
Headache with a fever, stiff neck, mental confusion, seizures, double vision, weakness, numbness or speaking difficulties
Headache after a head injury, especially if the headache gets worse
A chronic headache that is worse after coughing, exertion, straining, or a sudden movement
New headache pain after age 50

How to Cope With Long-Lasting Headache

Even if it’s not a medical emergency, a headache that persists can take a real toll on your quality of life. For example, people with migraine know that when their headache begins they may lose a sizable chunk of productive work or family time. Arranging for strategies to cope for one day might be bearable, but being out of commission for two or even three days can be more difficult. Even the worry over an impending migraine, especially for those whose headaches are long or severe, can interfere with daily life.

Here are some ways to cope with a longer-lasting headache.

Treat the pain. If you don’t have a prescription and are relying on over-the-counter (OTC) medications for tension-type headaches, follow the dose recommendations carefully. Bear in mind, too, that repeated use of pain relievers that are available without a prescription can also cause medication overuse headache, per the Mayo Clinic. If you have been prescribed a medication for headache or migraine pain, take the amount your doctor has recommended.
Rest and relax. Sleep disorders and migraine appear to have a bidirectional relationship, according to a paper published in Therapeutic Advances in Neurological Disorders in December 2017. Insomnia is more likely if you have migraine, and migraine is more likely if you aren’t getting enough sleep. Even if you can’t fall asleep, resting and using relaxation techniques may help you feel better.
Get the support you need. If your headache lasts for more than a day or so, you may need to enlist some help from family and friends while you recover.

Preventing Long Headaches

The best strategy for coping with headaches and migraine is to avoid them if you can. Here are some prevention tips.

Try preventive medications. Talk to your doctor about medications that can help prevent tension-type headaches and migraine.
Reduce stress. Relaxation techniques such as biofeedback therapy may help.
Treat related problems. Attend to other health concerns, such as sleep disturbances, and get any needed depression treatment. Cognitive behavioral therapy (CBT) is an approach that can help with headache prevention and coping. A meta-analysis published in the British Journal of Pain showed that CBT can improve some headache-related outcomes.
Avoid triggers. Pay attention to the things that seem to set off a headache or migraine. Migraine can be triggered by change, says Goadsby, so it's a good idea to stay well-balanced.
Maintain a healthy weight. Although being overweight doesn’t cause migraine, it can increase your chances of developing a migraine, according to the American Migraine Foundation.
Make healthy choices. Don't smoke, exercise regularly, eat regular, balanced meals, drink lots of water, and limit your consumption of alcohol, caffeine, and sugar.

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