Treating Headaches That Won’t Go Away

Written by Stephanie Booth, Lori M. King, PhD
Medically Reviewed by Zilpah Sheikh, MD on August 06, 2024
16 min read

Most of the time, a headache has more than one cause. They result from many different things going on inside and around you. These can range from lack of sleep to foods you eat or changes in the weather. If you get one headache or migraine after another and over-the-counter (OTC) pain relief doesn’t help, you do have options. A headache specialist can help.

Some factors that can trigger a headache that won't go away include:

Caffeine withdrawal

Caffeine is probably the most widely used drug in the world. It affects the activity of an important brain chemical called adenosine. Researchers aren't sure of all of adenosine's effects, but they do know it calms your brain's electrical activity and opens up your blood vessels. Caffeine blocks some of these actions. But if you use caffeine every day, you develop a tolerance to it, and it has less effect on your brain's electrical activity and blood vessel size. So, caffeine withdrawal may lead to a significant increase in blood flow in your brain, which can trigger a headache.

Dehydration

Dehydration is when the amount of fluid that’s leaving your body (through sweat and urine) is more than the amount you’re taking in. When you’re dehydrated, your brain and other tissues in your body shrink. As your brain shrinks, it pulls away from the skull, which puts pressure on your nerves and causes pain. Even mild dehydration can cause a headache. The pain may be throbbing and constant. You'll usually also have other symptoms, such as dizziness, dry mouth, fatigue, muscle cramps, and dark pee. The human thirst mechanism isn't very efficient, so if you're feeling thirsty, you're probably already a little dehydrated. Drink water throughout your day, not just when you're thirsty.

Headaches and sleep

About 50%-75% of people with headache disorder also have insomnia. Researchers aren't sure if the headache disorder causes insomnia or if it's the other way around. But it's clear that not getting enough sleep or getting too much sleep can trigger headaches, especially migraine attacks. For instance, getting too little sleep the night before can change the way your body processes pain signals. The key to avoiding sleep-related headaches is to have a regular sleep schedule that works for you. You may not need 8 hours every night, but you should aim for consistently getting enough sleep so that you feel well-rested and headache-free every day.

Headaches and diet

Eating certain foods, such as alcohol, chocolate, aged cheese, cured meats, smoked fish, yeast extract, food preservatives that contain nitrates and nitrites, artificial sweeteners, and monosodium glutamate (MSG), can trigger migraine attacks. And so can skipping meals, probably because of low blood sugar. If you have a primary headache disorder, such as migraine, you may be able to help avoid attacks by eating small, frequent meals throughout the day. And avoid eating things that trigger your attacks. If you're not sure, keep a headache diary for a few weeks. It can help you figure out if something you're eating or your eating schedule is causing your headaches.

Headaches and vision

People with migraine attacks may have visual symptoms, before, during, or after their headache. Focusing on your computer or phone for too long may also cause a headache. Contrary to popular myth, however, this type of headache is most likely a tension-type headache that doesn't have anything to do with your vision. Most headaches are not due to eye strain. Headaches associated with nausea or vomiting and those that follow a pattern, including a daily pattern, are likely not caused by eye strain.

Environmental factors

Environmental factors are common migraine attack triggers. Sometimes, just a minor change in your environment can set a migraine attack off. Triggers can include:

  • Pressure changes related to the weather (barometric pressure)
  • Change in temperature or humidity levels
  • Change in altitude
  • Bright sunlight
  • Flickering lights (such as reflections of sunlight or glare off surfaces, watching TV or a movie in the theater, or fluorescent lighting)
  • Poor air quality
  • Exposure to tobacco smoke
  • Dry, dusty weather
  • Being out in the wind
  • Strong smells

Neurological problems

Many neurological problems cause headaches. In fact, migraine is a neurological condition. "Neurological" means that it affects your nervous system (your brain and spinal cord). So, it makes sense that neurological conditions can cause headaches. However, if you get new headaches, especially if you're older, or you have any "red flag" signs, such as a sudden, severe headache, severe pain, double vision, or weakness, go to the ER right away.

Sinus headache that won't go away

A sinus headache may make feel like a constant, dull ache behind your forehead, eyes, cheekbones, or across the bridge of your nose. Your pain may get worse if you shift your head suddenly or bend over. A sinus headache is usually caused by a bacterial or viral sinus infection. But, you may also get it from sinus pressure caused by allergies, nasal polyps, or a deviated septum.

Your sinus headache should go away once you treat the underlying cause. For instance, viral sinus infections generally clear up on their own within a week. If your sinus headache won't go away, you may have a bacterial or fungal infection, and you need an antibiotic or antifungal medicine to get rid of it. Or you may have nasal polyps that need to be removed surgically. If you have a sinus headache that won't go away after about a week, get checked out by your doctor. 

Migraine that won't go away

Migraine attacks cause a throbbing or pulsing headache on one side of your head. Your pain may worsen with bright lights, loud noises, strong smells, and physical activity. Migraine attacks may go through four stages that take about 8-72 hours to go through:

  1. Prodrome: This starts about 24 hours before your headache starts. You may feel moody and have trouble concentrating and sleeping.
  2. Aura: These are warning signs of your headache and include vision changes, ringing in your ears, and muscle weakness. You may get them about 5-60 minutes before your headache starts.
  3. Headache: It generally lasts about 4-72 hours. Along with the headache, you may also feel nauseated, very hungry or thirsty, and very tired.
  4. Postdrome: It starts after your headache stops and may last about 4-48 hours. Some people call this a "migraine hangover" because the symptoms are very similar to an alcohol hangover. You may have trouble concentrating, extreme tiredness, nausea, dizziness, and a stiff neck.

A migraine attack that lasts longer than 72 hours and is more severe than usual is called status migrainosus. These can be dangerous, especially if you can't hold food and water down because you're nauseated and vomiting. Any migraine attack that lasts longer than 3 days warrants a visit to your doctor. These types of migraine attacks may be more common after a head injury and certain viral infections. It may also mean your migraine treatment plan needs a revisit. You may need a dose or timing adjustment of your current medicine, a new medicine, or a tweak to your lifestyle to help prevent your attacks.

Tension headache that won't go away

A tension headache may feel as if you have a band wrapped around your head. You will likely feel pressure on both sides of your head, especially in your temples and forehead. You may also have soreness and tightness in your neck and shoulders. Tension headaches probably have more than one cause. However, doctors think it's triggered when you tense the muscles in your neck and head due to emotional stress or even poor body mechanics while you're working.

Tension headaches may last as short as 30 minutes or as long as a week. If you have chronic tension headaches, you may even feel as if your headache won't go away. Your doctor can help you figure out ways to effectively manage your stress or make suggestions to help you change your body mechanics if you have chronic tension-type headaches.

Medication-overuse headache

It is a chronic daily headache. It usually happens in people who already have a primary headache disorder, such as migraine, and take pain medicine more than two to three times per week for it. You'll usually have this type of headache almost every day and often get it first thing in the morning. You may feel nauseated, anxious, irritable, depressed, weak, and restless. You may also have trouble concentrating and remembering things.

To help avoid getting medication-overuse headaches, limit the amount of medicine you take for your primary headache. Here are some guidelines based on the type of medicine you take:

  • NSAIDs, such as ibuprofen and naproxen. Don't take these more than 15 days per month. Ideally, don't take these more than two to three times per week.
  • Combination pain relievers with caffeine, aspirin, and acetaminophen or butalbital. Don't take these more than 10 days per month.
  • Triptans (such as sumatriptan) or ergotamines (such as Ergomar). Don't take these more than 10 days per month.
  • Opioids, such as oxycodone, hydrocodone, butorphanol, morphine, and codeine. Don't take these more than 10 days per month.
  • Caffeine. Limit yourself to less than 200 milligrams per day. Taking in more than this can increase your risk of getting medication-overuse headaches. For reference, an average 8-ounce cup of coffee has about 80-100 milligrams of caffeine. And many OTC headache medicines also contain caffeine. So, make sure you read the label of any OTC medicines you use because you could be taking in more caffeine than you think.

If you have a primary headache disorder that you regularly take medicine for and you're having daily or near-daily headaches, visit your doctor. They can help you make adjustments to your medicines and lifestyle to keep your headache problems from getting worse.

Chronic daily headache

If you get headaches on 15 or more days per month for longer than 3 months, you may have chronic daily headache. These can be associated with several different types of primary headache disorders, including:

  • Chronic migraine
  • Chronic tension-type headache
  • Medication-overuse headache
  • New daily persistent headache. These headaches usually start suddenly in people without a history of headache disorder. They are usually constant after the first headache. They usually cause mild to moderate pressure or tightness on both sides of your head.
  • Hemicrania continua. These headaches are usually continuous, with no pain-free periods. You will likely have moderate pain with severe spikes of pain on one side of your head. You will also usually have tearing or redness of your eye, nasal congestion, or a runny nose on the same side as the headache. Your eyelid may also droop or your pupil may narrow on the same side. You may also feel restless during your headache.

Cluster headache

Cluster headache usually causes severe, daily headaches on one side of your head, often around your eye or temple, above your eye, or behind your ear. The pain may be sharp, stabbing, or burning. Typically, each episode lasts 30 minutes or longer and you have several (sometimes up to eight) episodes a day. Episodes usually follow a pattern, so you will get headaches around the same time each day. For instance, you may have episodes about 1-2 hours after you fall asleep every night. Each cycle of cluster headache can last weeks to months.

Hormonal headache (or menstrual migraine)

These are a common type of migraine attacks that happen around the time of your menstrual cycle. About 60% of people who have migraine headache disorder and have a period have an attack around the time of their period. They may start a couple of days before your period and then last several days during that time. As with any other migraine, the pain is usually on one side of your head and may get worse due to light, smells, sounds, or as you move around. Doctors think it's related to the drop in your estrogen level that triggers your period to start.

If you have daily headaches or a headache that won't go away, it's time to visit your doctor. They will need to rule out any underlying medical problems, especially if you have any of the following:

  • The same type of headache several times a month
  • Headaches that last longer than a day
  • Repeated headaches in the same place on your head
  • Your headache never fully goes away

 

 

Your primary care doctor may refer you to a few different specialists, depending on your symptoms and any other medical conditions you have. For instance, you may get a referral to the following specialists:

  • Neurologists. These are doctors who diagnose and treat disorders of the brain and nervous system (your spinal cord and nerves).
  • Headache specialists. These are doctors who have extra training in the diagnosis and treatment of head pain disorders. Sometimes, these doctors have a United Council for Neurologic Subspecialties (UCNS) certification but not always.
  • Otolaryngologists (or ear, nose, and throat doctors). Your doctor may refer you to an otolaryngologist if they suspect your headaches are related to sinus pressure. 
  • Ophthalmologists (eye doctors). Your doctor may suggest you get an eye exam if you have ocular or retinal migraines.
  • Obstetricians and gynecologists(OB/GYN). Your doctor will likely want to loop your OB/GYN into the conversation if you have new headaches and you're pregnant or just gave birth.

 

There isn’t a one-size-fits-all approach; the best treatment depends on the type of headaches you get. For instance, if you have headaches due to an underlying medical condition (called a secondary headache), your doctor will usually start by treating that condition. If you have primary headaches, such as migraines or tension headaches, your doctor will base your treatment plan on how bad your symptoms are and how much they affect your day-to-day life.

Treatment will usually include one or more of the following:

Immediate treatment

For occasional headaches, your doctor may suggest you take an OTC pain reliever, such as ibuprofen, naproxen, aspirin, or acetaminophen. But if you take them more than 2 days a week, you may get medication overuse headaches. These can be daily and long-term. 

If you already have frequent, severe headaches or ones that won't go away, your doctor may suggest you take a prescription headache medicine, such as:

  • Triptans such as sumatriptan (Imitrex) or zolmitriptan (Zomig). Triptans change the way blood circulates in your brain and how your brain processes pain signals. This helps stop your headache before it gets worse. 
  • Barbiturates such as butalbital. Barbiturates act directly on your nervous system to relieve pain and relax you. A combination medicine with butalbital and acetaminophen (Fioricet) is prescribed to treat tension and some other types of headaches. However, barbiturates can be habit-forming, so you'll need to follow your doctor's advice carefully while taking them.
  • Narcotics, such as oxycodone hydrochloride (OxyContin), hydrocodone plus acetaminophen (Vicodin), or oxycodone plus acetaminophen (Percocet). These aren't used very often because they may not work as well as triptans and are highly habit-forming. They are also easy to overuse, which sets you up for medication overuse or rebound headache.

Preventing headaches

If you have headaches more than a couple of times a week, your doctor will likely prescribe you a headache prevention medicine, such as:

  • Amitriptyline (Elavil, Vanatrip), a tricyclic antidepressant that is also used as a pain medicine. Studies also show that it can help prevent headaches, especially mixed migraine-tension types. 
  • Divalproex (Depakote) and sodium valproate (Depacon), which are anticonvulsant medicines often prescribed to prevent prolonged or atypical migraine attacks.
  • Erenumab (Aimovig), a biologic medicine that changes the way your brain processes migraine pain.
  • Metoprolol (Lopressor) and propranolol (Innopran, Inderal), which are beta-blockers most often used to treat high blood pressure. But they also seem to help prevent headaches since they change the way blood circulates in your brain.
  • Topiramate (Topamax, Trokendi), an anti-seizure medicine that works to prevent migraine attacks by calming certain parts of your nervous system.
  • Venlaxafine, another antidepressant that can work to prevent migraine attacks.

Alternative treatment for headaches

Many people find alternative therapies helpful, too. Your headache specialist may suggest you try:

Herbs, such as butterbur and feverfew. Butterbur seems to have the best evidence supporting its efficacy in preventing headaches. However, there may be safety concerns because some herbal brands contain chemicals called pyrrolizidine alkaloids (PAs), which are made by the plant. PAs can cause damage to your liver and lungs, and can also cause your blood to clot. Over the long term, PAs can also cause cancer. However, PAs can be removed during the manufacturing and purification process of butterbur. So, if you want to try it to prevent headaches that won't go away, look for brands that can confirm their products are free of alkaloids.

Supplements, such as magnesium, coenzyme Q10, and vitamin B2. Studies show that magnesium oxide at 400-600 milligrams per day works to prevent headaches from migraine attacks with aura and those you get around the time of your period. The American Headache Society and the American Academy of Neurology both say it's probably worth trying because it doesn't have any serious side effects, and it won't interfere with other preventive treatments you may take. It's even safe to take up to 400 milligrams per day during pregnancy.

Some studies show that coenzyme Q10 at 150 milligrams per day and vitamin B2 (riboflavin) at 400 milligrams per day may help prevent migraine attacks or reduce their severity.

Other therapies or practices, such as:

Small tweaks in your daily routine can lower the number of headaches or migraine attacks you have. Try the following:

  • Keep a consistent sleep schedule. Aim to get enough sleep every night so that you wake up feeling well-rested. Most people need about 7-8 hours a night, but do what works for you.
  • Exercise regularly and maintain a healthy weight. Some studies show that getting about 30-50 minutes of moderate-intensity activity 3-5 days a week is more effective for some people than preventive medicines.
  • Drink at least eight 8-ounce glasses of water a day to stay hydrated.
  • Eat regular meals.
  • Limit your caffeine and alcohol intake.
  • Manage your other health problems. Conditions such as anxiety or high blood pressure can trigger headaches if you don’t keep them under control.
  • Watch your use of pain medicines. Taking OTC pain relievers too often or at a higher dose than the label says could cause more frequent and more severe headaches. Once the drug wears off, withdrawal symptoms start. This leads to increased head pain and the need for more medicine. Doctors call this a rebound headache.
  • Track your headaches. Write down when you get one and what you were doing right before. Make sure to include what, if anything, helped ease your pain.
  • Use healthy ways to manage your stress. Stress can trigger headaches, so managing your stress can be a good way to help prevent headaches. Try relaxation techniques, mindfulness practices, meditation, and breathing techniques. Also, limit your time on social media, watching TV, or consuming news content.

"Red flag" signs suggest that your headache may be caused by another medical condition that could be serious. If you have any of these "red flag" signs, you should go to the ER right away:

  • A sudden, severe headache
  • Pain so severe it feels like the worst headache of your life
  • Getting a severe headache when you rarely or never get headaches
  • New headache pain when you are over the age of 50, are pregnant, have recently given birth, or have cancer, risk factors for HIV, or a weakened immune system
  • You have other "red flag" symptoms along with your headache, such as fever, shortness of breath, a stiff neck, double vision, confusion, nausea, vomiting, weakness (especially if it's only in one arm or leg), numbness, or night sweats
  • Headaches that get worse over time and happen more often
  • Headaches that get worse or better when you change position (such as going from standing to lying down), cough, sneeze, or strain yourself
  • Your headache started after head trauma

Remember, an ER doctor isn’t a headache specialist. Their focus will be to rule out serious health issues that cause head pain, such as meningitis or a stroke. They may suggest some imaging tests, such as a CT scan that takes a picture of the inside of your head.

They’ll probably give you a drug to ease your pain, but it may only work for a short time. See a headache specialist. It’s the best way to get your headaches under control and come up with a long-term treatment plan.

Headaches are complex because they usually have more than one cause. Everything from the weather to your individual food choices can raise your chance of getting a headache if you're prone to them. If you have migraine or tension-type headaches and you take pain medicine more than a couple of times a week, you could have medication-overuse headache. This is a common cause of headaches that won't go away. Or you may have developed a new trigger. Either way, your doctor can help you adjust your headache management plan. If you've developed a new headache as an adult, especially if it happens every day or nearly every day, it warrants a checkup with your doctor.

How to reduce headaches naturally

Make a few lifestyle changes to help you better manage your headaches, such as:

  • Stay hydrated.
  • Exercise moderately.
  • Eat a healthy diet.
  • Try massage therapy.
  • Practice meditation and other relaxation techniques, such as yoga.
  • Alternate heat and ice on your shoulders and neck.
  • Drink something with a bit of caffeine -- just try to keep it under 200 milligrams a day.

What to do when your headache won't go away

Visit your doctor if you have a headache that won't go away. If you're prone to headaches and have one that won't go away, you may need to rethink your headache management plan. Your doctor can help you do that. If you aren't prone to headaches but you've recently begun having them, you should get checked out by your doctor. They will need to make sure you don't have an underlying medical condition that could be causing your headache.

What to do if headache medicine no longer works

If OTC headache medicines, such as ibuprofen or naproxen, no longer work to relieve your headache, you may need to try prescription medicines. You may have developed a tolerance to OTC headache medicines, or you may need to try a different type of medicine. Either way, your doctor can help you figure this out.

Print
View privacy policy, copyright and trust info
View privacy policy, copyright and trust info