When Headaches Become Chronic: Knowing When to See a Pain Specialist

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Your Health Magazine Contributor

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When Headaches Become Chronic: Knowing When to See a Pain Specialist

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Most people have a go-to routine for a headache. A couple of pain relievers, a glass of water, maybe a dark room for an hour. For an occasional headache, that is often enough.

The problem starts when the occasional headache becomes a weekly or even daily one. Many people keep reaching for the same quick fixes for months or years without ever getting a proper diagnosis, even as the headaches start to shape their work, sleep and plans. Knowing what separates an everyday headache from migraine, and recognizing when self-care is no longer working, can shorten the road to real relief.

Migraine Is Common and Often Underdiagnosed

Migraine is one of the most widespread headache disorders in Canada. In its analysis of national health survey data, Statistics Canada estimated that 8.3 per cent of Canadians, or about 2.7 million people, had been diagnosed with migraine by a health professional, with a slightly higher rate of 8.8 per cent in Ontario. Women were more than twice as likely as men to report a diagnosis.

The agency also noted that the figure likely underestimates how many people live with migraine, since some never seek professional care. Among those who were diagnosed, the diagnosis came on average 3.6 years after symptoms first appeared. That is a long time to manage frequent attacks without a clear plan.

How Migraine Differs From an Everyday Headache

A typical tension-type headache feels like a dull band of pressure and usually does not stop you from getting through the day. Migraine tends to be more disruptive. Common features include:

• Moderate to severe throbbing pain, often on one side of the head.
• Nausea or vomiting.
• Sensitivity to light, sound or smells.
• Pain that worsens with routine physical activity.
• In some people, visual or sensory changes known as aura before the headache begins.

Attacks can last from a few hours to several days. When headaches occur on 15 or more days a month for at least three months, they are generally considered chronic, and that pattern calls for a closer look.

When Pain Relievers Start Working Against You

It seems logical to take something every time a headache starts. But relying on acute headache medication too often can lead to medication overuse headache, sometimes called rebound headache, where frequent use of pain relievers contributes to more frequent headaches over time.

This is a real concern in Ontario. A population-based study by McMaster University researchers of publicly funded triptan use in 2012, a common class of migraine medication, found that the share of patients treated with more than six units per month ranged from 2.1 per cent in Saskatchewan to 43.8 per cent in Ontario. The authors noted that high volumes of triptan use may place patients at risk for medication overuse headache.

If you find yourself treating headaches on more days than not, or needing more medication than you used to for the same relief, that is a sign to talk with a health care provider rather than simply increasing the dose.

Signs It Is Time to See a Specialist

Your family doctor is the right first stop for most headaches. A referral to a pain or headache specialist may make sense when:

• Headaches occur on 15 or more days a month.
• You are using pain relievers more than two or three days a week.
• Over-the-counter and first-line prescription treatments are no longer helping.
• Headaches are causing you to miss work, school or family commitments.
• Your headache pattern has changed noticeably over time.

Some headaches need urgent care instead. A sudden, severe headache that feels like the worst of your life, or a headache with weakness, confusion, trouble speaking, vision loss, fever or a stiff neck, requires emergency medical attention.

What a Pain Clinic Can Offer for Chronic Headaches

A pain clinic looks at the full picture: how often your headaches occur, what triggers them, what you have already tried and how much medication you are using. That assessment helps separate migraine from other headache types and identify contributing factors such as medication overuse, sleep problems or muscle tension in the neck and shoulders.

Treatment plans often combine several approaches. Depending on your situation, these may include adjusting acute medications, preventive treatments, Botox injections for chronic migraine in people who meet the criteria, interventional procedures such as nerve blocks, and guidance on sleep, stress and other daily habits.

In Ontario, PainCareClinics.com is a starting point for patients looking for that kind of support. Pain Care Clinics treats headaches and migraines as part of its comprehensive pain management services, offers Botox treatment and interventional pain management, and accepts both physician referrals and self-referrals at locations across the West GTA, Niagara, Kitchener and Windsor.

Frequently Asked Questions

How Do I Know if My Headaches Are Migraines?

Migraine often involves throbbing pain on one side of the head, nausea and sensitivity to light or sound, and it can be severe enough to interrupt your day. Only a health care provider can confirm a diagnosis, so keep a headache diary to share at your appointment.

Can Taking Too Many Pain Relievers Make Headaches Worse?

Yes. Using acute headache medication very frequently can contribute to medication overuse headache. If you are treating headaches on most days, talk with your doctor before changing how much you take.

What Should I Track in a Headache Diary?

Note the date, how long each headache lasted, how severe it was, what you were doing beforehand, what you took for it and whether it helped. Patterns in sleep, meals, stress and menstrual cycles can also be useful.

When Is a Headache an Emergency?

Seek emergency care for a sudden, severe headache, or a headache with weakness, confusion, trouble speaking, vision loss, fever or a stiff neck.