Updated 16th March 2023
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
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.
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 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
Some ways to manage migraine pain include:
taking over-the-counter medications
avoiding intense sensory stimuli
practicing stress reduction techniques
In the long-term, certain lifestyle changes may help reduce the frequency or intensity of migraines.
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 (TTHs) are headaches that experts believe are associated with tightness in the head muscles.
A 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, TTHs 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 TTHs every year. TTHs 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 TTHs. While lifestyle changes can improve headaches that occur during a migraine, there is little evidence for their effectiveness in TTHs.
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 (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
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.
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
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 ingredients like caffeine and alcohol
ensuring you allow 7–8-hour periods for restful sleep
using massage therapy to reduce tension in your neck and shoulders
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.
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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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