When headaches stop being occasional and become chronic headache or migraine, the first job is to figure out what kind they are. That is because the treatments do not overlap.
What is mistaken for a migraine?
Migraine, tension-type headache, cervicogenic headache and occipital neuralgia are separate conditions. They routinely get lumped together.
Medication overuse headache is a common cause of daily headache that often gets missed. The treatment is causing the problem.
Post-traumatic headache after a crash often has a neck part to it.
How it usually presents
- Headache on more days than not.
- A pattern that has changed over time.
- Taking more and more over-the-counter painkillers.
- A stiff neck along with the headache.
- Poor sleep.
How are daily migraines and chronic headaches treated?
- A careful history. Here it tells us more than any scan.
- Occipital and sphenopalatine ganglion blocks where indicated.
- Treating the cervical spine (the neck) when it plays a part.
- Stopping overused painkillers (analgesics) when they are the driver.
To get checked, call us or request an appointment. If this began with a crash or a fall, see accident and injury care.
What usually gets missed
Medication overuse headache is the most often missed cause of daily headache. The treatment is causing the problem. Regular use of simple painkillers (analgesics) or triptans on more than ten to fifteen days a month keeps the headache going. Then the headache seems to call for more medicine.
The second miss is the neck. A real share of patients with a chronic migraine label have a treatable source in the upper neck. It is identifiable by diagnostic block (a numbing shot that tests where the pain comes from).
What to expect over time
Stopping an overused painkiller makes the headache worse for one to two weeks before it improves. That is why it fails without warning and support. Told in advance, most people get through it.
Chronic migraine responds to preventive treatment, including botulinum toxin on a set schedule. But that works only once any medication overuse and any neck driver have been addressed.
When is a headache an emergency?
Get emergency care for any of these: a thunderclap headache that hits its peak within a minute, headache with fever and a stiff neck, headache with new neurological signs, headache worse when lying flat or on coughing, or a first severe headache after fifty.
Related: for chronic migraine on fifteen or more days a month, see botulinum toxin injection.
What counts as a chronic headache?
Chronic headache is defined by how often it happens: headache on fifteen or more days a month. It is not one single cause. Under it sit several separate problems. These are chronic migraine, tension-type headache, cervicogenic headache that starts in the neck, and medication-overuse headache. That last one is common and often missed.
What it gets confused with
Medication-overuse headache needs its own mention because the treatment creates it. Frequent use of acute painkillers, including over-the-counter ones, can keep a daily headache going. It improves only once the pattern is broken. Knowing which type you have matters more than piling on treatment for the wrong one.
The metabolic side
Poorly controlled blood sugar, low vitamin D and a chronic inflammatory load all slow tissue repair in ways we can measure. Pain that will not settle sometimes has a reason outside the body part being treated. We check these when they matter. We address them alongside treating the body part itself, not in place of it.
Common questions
Can my neck cause headaches?
Yes. It is one of the most often missed causes of a one-sided headache that will not go away.
This is set out in Cervicogenic Headache.
Could my painkillers be causing this?
It is a real possibility if you often take acute medication, including over-the-counter painkillers. It is one of the first things we review.
How do you tell the types apart?
Mostly from the history. That means the pattern, the triggers, the associated features (other symptoms that come with it), and what medicine you take and how often. A headache diary helps more than another scan.
What happens when I stop overusing headache medicine?
Expect the headache to get worse for one to two weeks before it gets better. That rebound is why withdrawal often fails when nobody warns you about it. Told in advance, most people get through it. Frequent use of simple painkillers or triptans, more than ten to fifteen days a month, keeps a daily headache going, so breaking that pattern comes first.
Does Botox help chronic migraine?
Chronic migraine responds to preventive treatment, including botulinum toxin given on a defined schedule. It works best once two other problems have been dealt with first: any medication overuse headache and any part played by the upper neck. Treating chronic migraine while those drivers are still active means piling on treatment for the wrong problem. That is why we pin down the type of headache first.
Can a nerve block help my headaches?
It can when the nerves involved are part of the problem. Occipital nerve blocks and sphenopalatine ganglion blocks are used where they are indicated. A diagnostic block can also show whether the upper neck is driving the headache. A real share of people with a chronic migraine label have a treatable neck source. When the neck contributes, we treat the cervical spine as well.
Sources
- Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia : an international journal of headache, 2018. PubMed 29368949
- GBD 2016 Headache Collaborators. Global, regional, and national burden of migraine and tension-type headache, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet. Neurology, 2018. PubMed 30353868
- Ashina S et al. Medication overuse headache. Nature reviews. Disease primers, 2023. PubMed 36732518
- Diener HC et al. Drugs for Migraine Prophylaxis. Deutsches Arzteblatt international, 2026. PubMed 41572863
Hurt in an accident? Start here.
You do not need a lawyer, a police report or a referral to be seen. Bring your symptoms and we will work out the rest.
Monday–Friday, 8:00 a.m. – 4:00 p.m. Same-day appointments are often available for new accident and injury patients.