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Most people experience headaches from time to time. But for an estimated 4 percent to 5 percent of adults, headaches occur nearly every day. These are known as chronic daily headaches.

Doctors classify chronic daily headaches as either primary or secondary. Primary chronic daily headaches often develop in people who've had migraine or tension-type headaches for many years. Over time, these headaches gradually increase in frequency until they appear almost daily. Secondary chronic daily headaches are caused by an underlying disease or condition.

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 headaches.

By definition, chronic daily headaches occur more than 15 days a month — often daily. The signs and symptoms vary depending on the specific type of chronic daily headache. Here are a few examples:

Chronic daily headache in migraine
Sometimes migraines gradually become more frequent, until you experience pain nearly every day. This is known as transformed migraine. You may feel steady pain on one or both sides of your head, as well as pain in your neck and face. The common migraine symptoms of nausea and sensitivity to light and sound often fade, but you may continue to experience occasional acute migraine attacks. Depression, sleep disturbances, anxiety and panic are common as well.

Chronic tension-type headache
Occasional tension-type headaches sometimes progress to daily attacks. The pain involves both sides of the head and the back of the head and neck. It's often described as a dull ache or a tight band of pressure around the head. The pain may fluctuate throughout the day or be steady for days, weeks or even years at a time.

New daily persistent headache
New daily persistent headaches begin abruptly in people without a history of headaches. Sometimes the headaches are triggered by an infection, surgery or stressful life event, but often there's no recognized trigger. The pain is often described as throbbing, dull, achy, stabbing or burning, or as pressure or tightness. The pain continues unabated throughout the day. Some new daily persistent headaches go away within several months. Others persist for years or even decades.

Hemicrania continua
Hemicrania continua is a relatively rare type of chronic daily headache. The pain occurs on one side of the head and varies in intensity without ever disappearing completely. The pain is usually moderate but may include jolts of severe pain that last less than a minute. The flare-ups of severe pain may be accompanied by tearing or redness of the eye on the affected side, swelling or drooping of the eyelid, and a stuffy or runny nose. You may experience nausea, vomiting and sensitivity to noise and light. Sometimes auras — such as blind spots or flashing lights in your visual field or sensations of numbness or tingling — are present as well.

In the episodic form of hemicrania continua, periods of time — usually months — with daily headaches alternate with periods with no headaches. In the chronic form, headaches occur daily with little or no break, sometimes for years.

The causes of chronic daily headaches are not well understood. For primary chronic daily headaches, possible factors may include:

• Medication overuse
• Abnormal response of the brain to stimulation, such as muscle tension or tissue inflammation
• Abnormal function of brain structures that suppress pain
• Changes in the nervous system due to frequent headaches
• Stimulation of the central nervous system due to stress, infection or trauma
• Genetic predisposition to increased pain sensitivity
• Injury to or painful stimulation of the upper spine

Secondary chronic daily headaches may be caused by various underlying diseases or conditions, including:

• Inflammation of the arteries (giant cell arteritis)
• Inflammation of the blood vessels (vasculitis)
• A new, abnormal formation of tissue (neoplasm)
• Infection
• Sleep disorders (such as obstructive sleep apnea)

Chronic daily headaches are more common in women than in men. Various factors may increase the risk of developing chronic daily headaches, including:

• Anxiety
• Depression
• Sleep disturbances
• Obesity
• Snoring
• Overuse of caffeine
• Overuse of pain medication (on average, more than 2 days a week or 9 days a month)

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

• You usually have three or more headaches a week
• You take a pain reliever for your headaches every day or almost every day
• You take 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, rash, confusion, seizure, double vision, weakness, numbness or difficulty speaking
• Follows a head injury
• Gets worse despite rest and pain medication

The doctor will ask a series of questions about your headaches, including when they started and what they feel like. Be sure to list all the medications you're taking, including the doses.

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, computerized tomography or magnetic resonance imaging — are recommended.

Sometimes efforts to control headache pain actually cause problems. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen may cause side effects such as abdominal pain, bleeding and ulcers — especially if taken in large doses or for a long period of time.

If you take pain medication more than two or three times a week or in excessive amounts, you may be setting yourself up for a serious complication known as rebound headaches. Although pain medication can provide temporary relief, taking too much may actually fuel recurrent headaches. You then use more pain medication, which traps you in a vicious cycle of headaches.

Treatment for any underlying diseases or conditions often stops chronic daily headaches.

When no underlying diseases or conditions are present, treatment focuses on stopping the pain before it starts. Specific prevention strategies vary, depending on which type of headache you have and on 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 — including amitriptyline and nortriptyline (Aventyl, Pamelor) — are the most common preventive medications for all types of chronic daily headaches except hemicrania continua. These medications can also help treat the depression, anxiety and sleep disturbances that often accompany chronic daily headaches. Another antidepressant — such as the selective serotonin reuptake inhibitor (SSRI) fluoxetine (Prozac) — may occasionally be an effective alternative for some people.
• Beta blockers. These drugs, commonly used to treat high blood pressure, are also a mainstay for preventing episodic migraines. Beta blockers include atenolol (Tenormin), metoprolol (Lopressor, Toprol), nadolol (Corgard), propranolol (Inderal) and timolol (Blocadren). Sometimes beta blockers are prescribed in combination with antidepressants for better results.
• Anti-seizure medications. Some anti-seizure drugs seem to prevent migraines. Now these medications may be used to prevent chronic daily headaches as well. Options may include divalproex (Depakote), gabapentin (Neurontin) and topiramate (Topamax).
• Muscle relaxants. Muscle relaxants such as tizanidine (Zanaflex) may help some people manage chronic daily headaches.
• NSAIDs. Nonsteroidal anti-inflammatory drugs — such as naproxen (Aleve, Anaprox), ketoprofen (Orudis) and mefenamic acid (Ponstel) — may be helpful, especially if you're going through withdrawal from other pain relievers.
• Others. Injections of a local anesthetic around a nerve (nerve block) or injections of a numbing agent and corticosteroid at the point of pain (trigger point injections) are sometimes recommended for chronic daily headaches. Although controversial, botulinum toxin type A (Botox) injections provide relief for some people as well.

Unfortunately, some chronic daily headaches remain resistant to medications.

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's 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.
• Get enough sleep. Go to bed and wake up at the same time every day — even on weekends. If you're not tired at bedtime, read or watch television until you become drowsy and fall asleep naturally.
• Don't skip meals. Start your day with a healthy breakfast. Eat lunch and dinner at about the same time every day. Avoid any foods that seem to trigger headaches.
• Exercise regularly. Physical activity causes your body to release chemicals that block pain signals to your brain. With your doctor's OK, choose activities you enjoy — such as walking, swimming or cycling. To avoid injury, start slowly.
• Reduce stress. Get organized. Simplify your schedule. Plan ahead. Stay positive.
• Relax. Try yoga, meditation or relaxation exercises. Set aside time to slow down. Listen to music, read a book or take a hot bath.
• Quit smoking. If you smoke, talk to your doctor about quitting. Smoking can trigger headaches or make them worse — especially chronic daily headaches with migraine and chronic tension-type headaches. Higher levels of nicotine are also associated with increased anxiety and depression.

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. When your head is throbbing, companionship may be the last thing on your mind — but perhaps it's just what you need. A support group can put you face to face with people who share your physical symptoms and emotional responses. You may learn useful coping strategies — or help others by sharing some of your own.
• Consider counseling. A counselor or therapist can help you manage stress and maintain your emotional balance. Through therapy, you can learn to change behavior that's not good for you and reinforce behavior that's helping you manage your headaches.

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 to promote the release of natural painkillers and other chemicals in the central nervous system. There is some evidence that it can help control headaches and other conditions that cause chronic pain.
• Biofeedback. With this relaxation technique, you can learn to control headaches by producing changes in bodily responses such as muscle tension, heart rate and skin temperature.
• Hypnosis. During a hypnosis session, a trained hypnotist might suggest ways to decrease your perception of pain and increase your ability to cope with it — such as visualizing a calm, safe place when a headache strikes.
• Meditation. During meditation, you focus on a simple activity, such as breathing or repeating a single word or phrase. The practice creates a deeply restful state in which your breathing slows and your muscles relax — which can help you manage pain and reduce the stress that can trigger or worsen a headache.
• Massage. Massage can reduce stress, relieve tension 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 dietary supplements — including magnesium, feverfew and butterbur — seem to help prevent or relieve some types of headaches, but there's little scientific support for these claims. If you're considering using supplements to treat headaches, check with your doctor. Some supplements may interfere with the effectiveness of prescription or over-the-counter drugs or have other harmful effects.
• Chiropractic care. Spinal manipulation can effectively treat some types of pain, but studies don't support claims that chiropractic care relieves headaches. Chiropractic manipulation of the neck has been associated with injury to the blood vessels supplying the brain. Rarely, this may cause a stroke.

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