How to Evaluate the Potential Severity of Chronic Headaches

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methods

1Using Objective Criteria

2Using Subjective Criteria

3Getting Treatment

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Judging the severity of a recurring headache or cluster of headaches requires looking at both the objective and subjective evidence. Objective evidence includes things like the headache type, location, and duration. Subjective evidence includes things like your pain level and what helps with the pain. For instance, you could use the duration, location, and presence or absence of side effects to determine the severity of the headache. You could use subjective criteria like a ranking on a scale of one through ten or speed with which the headache arrived. It is important to document both the subjective and objective criteria and communicate this information to your doctor. Seek treatment from your doctor if you’re experiencing chronic headaches – they might be caused by an underlying medical condition.

Steps

Method 1

Method 1 of 3:

Using Objective Criteria

1. 
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   Determine if the headache is a primary headache. Doctors classify headaches into two basic types, primary and secondary. Chronic primary headaches are those that are recurrent but are not caused by an underlying disease.

   • Either primary or secondary headaches may be chronic, though chronic headaches tend to be classified as primary.
   • Primary headaches may be caused by exposure to very cold temperatures, sexual intercourse, or coughing excessively. The main types of primary headaches are tension headaches, migraines, and cluster headaches.
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   Determine if the headache is a secondary headache. Chronic secondary headaches, unlike primary headaches, are caused by a medical condition. If you have a chronic secondary headache, your situation is more serious. The condition underlying your chronic headaches could be life threatening, so you should see a doctor as soon as possible.

   • Conditions that may lead to secondary headaches include concussions, whiplash (or other injury to the neck, head, or back), stroke, seizures, AIDS, meningitis, high blood pressure, dehydration, or allergies. These conditions require a doctor’s diagnosis and medical treatment.
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   Evaluate the length of the headache. The three main types of chronic headaches – all of which are primary headaches – all last for different lengths of time. One way to evaluate the severity of the chronic headache is to identify how long it lasts.

   • Tension headaches tend to last less than 30 minutes. They occur as a response to stress or difficulty at school, work, or another social situation. They are the most common type of chronic headache.
   • Cluster headaches are a bit more severe. They typically last 30 to 60 minutes and occur regularly (in “clusters”) over a period of days, weeks, or months, then disappear.
   • Migraines are the most intense and severe headaches. They usually last between four and 24 hours, but they can occur continuously for up to three days.
4. 
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   Consider the side effects. Each of the three major types of chronic headaches have side effects that differ in severity. The severity of the side effects generally corresponds to the duration of each major type of headache. In other words, shorter headaches tend to have fewer side effects. Use the extremity and the number of side effects most commonly associated with the three major types of chronic headaches to better evaluate their potential severity.

   • The side effects of tension headaches tend to be mild or moderate. The only symptom is pain in and around the head, neck, and shoulders.
   • Cluster headaches have more severe side effects. You could potentially experience a stuffy or runny nose, forehead or facial sweating, watery or irritated eyes, and/or a droopy or swollen eyelid (ptosis or edema, respectively) in addition to a stabbing pain in the eye or temple.
   • Migraine headaches tend to have the worst side effects. In addition to throbbing or pulsating pain, you could experience nausea or vomiting, sensitivity to light or sound (photophobia or phonophobia, respectively), or visual disturbances.
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   Consider the location of the headaches. Chronic headaches might affect the neck, left and right sides of the head, scalp, upper back, and/or shoulder muscles. The more areas of your neck, head, and/or body that are tense or in pain, the more severe the headache is.
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   Ask the right questions. If you are trying to gauge the potential severity of someone else’s headache, engage them in conversation. Listening to what the person suffering from the headache has to say will help you better evaluate the severity of their headache. Ask questions like:

   • What sort of side effects are you experiencing?
   • How would you rate your pain on a scale of one through ten?
   • When did your headache begin?
   • Where is the pain?
   • Do you have any other medical issues?
   • Are you taking medication?
   • Have you recently undergone surgery?
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Method 2

Method 2 of 3:

Using Subjective Criteria

1. 
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   Rank your headache. To determine how severe someone’s headache is, you could ask them to rate their headache on a 1-10 scale. On this scale, 10 would be the most painful headache ever experienced, while 1 is the least severe headache possible.

   • If you want to attach a verbal description to your ranking system, you might describe a headache ranked 1-3 as dull, 4-5 as mild, 6-7 as moderate, and 8-10 as intense or severe.
2. 
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   Consider other subjective descriptions. People with chronic headaches might describe the feeling as having their head in a vise. If your headache is more severe, you might employ a more colorful description. For instance, you might say, “I feel as though an elephant is crushing my skull.” Think about the description you use and comparisons you make to evaluate the potential severity of your chronic headache.
3. 
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   Factor the effectiveness of home care. When people have mild or moderate chronic headaches, they are typically able to cope with them using only conventional, over-the-counter painkillers. But if you have a very severe chronic headache, commercially available medication or other treatments – including cold packs, hot packs, or a gentle massage of the temples – will not relieve your pain.
4. 
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   Identify the suddenness of the headache. Headaches that arrive suddenly – known as thunderclap or severe onset headaches – are considered the most severe type of chronic headache. These headaches also have serious consequences, or they may be a secondary symptom of an underlying condition that only your doctor can detect.

   • Some serious, life-threatening underlying causes of a secondary headache may include subarachnoid hemorrhage or intracranial hemorrhage (bleeding in the brain), vertebral artery dissection (a tear in the artery that supplies the brain with blood), cerebral venous thrombosis (a condition that causes blood to collect in the brain) or reversible cerebral vasoconstriction syndrome (the narrowing of blood vessels in the brain).
   • There is no discrete time period in which a headache starts that defines it as “sudden.”
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   Evaluate the headache’s impact upon regular daily activities. If your chronic headache is so intense that it prevents you from working, studying, or enjoying social situations, it is more severe than a chronic headache that does not. You can use the impact of chronic headaches on your daily life to better gauge their severity.

   • Count the occasions that a chronic headache kept you from enjoying yourself fully, sent you home from work, or prevented you from attending an event or social situation. The more occasions in which this occurs, the more severe your headache.
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Method 3

Method 3 of 3:

Getting Treatment

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   Talk to a doctor. Your doctor will be able to help you develop a treatment plan to combat and manage your chronic headaches. They might recommend self-care techniques, prescribe medication, or refer you to a specialist who can better help you cope with your condition.

   • If you’re suffering from a secondary headache, a doctor may be able to treat your underlying condition and – hopefully – eliminate the headaches.
2. 
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   Identify and avoid your triggers. If you have a chronic primary headache, you might be able to identify a trigger that causes the headache. For instance, if you experience a headache every time you eat figs, you should avoid eating figs. Take careful note of the conditions under which your chronic headaches begin and end in order to identify factors that might contribute to your headaches and avoid them when possible.

   • Other foods that might cause headaches include canned soup, nuts, peanut butter, raisins, soy sauce, sauerkraut, lentils, papaya, passion fruit, avocados, aspartame (i.e. Equal or NutraSweet), processed meat, and alcohol.
   • Other potential triggers include allergens (dust, ragweed pollen, or other environmental contaminants) that could cause intense sneezing fits and headaches. If these are your triggers, dust and vacuum more often, keep your windows sealed tight or open (depending on your trigger), and invest in a small air purifier or air filtration system.
   • Cold or hot weather, or rapid changes in temperature, might also produce headaches.
3. 
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   Take over-the-counter (OTC) medications. Some OTC medication can help you fight your chronic headaches. For instance, you might be able to take aspirin, acetaminophen (commercially available as Tylenol), ibuprofen (commercially available as Motrin), naproxen (commercially available as Aleve), or ketoprofen (commercially available as Orudis KT). You might also benefit from an OTC dug that combines more than one of these ingredients (such as Excedrin Migraine).

   • Always be sure to follow the dosing instructions on the medication package. If the dose specified on the package is not relieving your pain, do not take a higher dose. Contact your doctor.
4. 
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   Use prescription medication. If your chronic headache pain and side effects are severe, you’ll likely need prescription medication. Consult your doctor to obtain prescription medication and make sure to take them exactly as directed. Let your doctor know about any side effects you have from the medication as well. They might provide you with drugs like ergotamine (commercially available as Ergostat) or dihydroergotamine (commercially available as Migranal or D.H.E. 45). Your doctor might also recommend:

   • Sumatriptan (commercially available as Imitrex)
   • Zolmitriptan (commercially available as Zomig)
   • Naratriptan (commercially available as Amerge)
   • Rizatriptan (commercially available as Maxalt)
   • Almotriptan (commercially available as Axert)
   • Frovatriptan (commercially available as Frova)
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   Practice self-care techniques. There are several simple remedies that might help you relieve your headache pain. For instance, you might lie down in a quiet, dark room and close your eyes. Put a cool cloth over your forehead. If you are not at home, you could place your index and middle fingers on your temples and massage them using gentle pressure. Move the tips of the fingers of your right hand in a slow clockwise motion against your right temple and move the tips of the fingers of your left hand in a slow counterclockwise motion against your left temple.
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   Visit a massage therapist. Deep-tissue massage can be beneficial for relieving chronic headache pain. Many hospitals offer massage therapy as part of their services, but if your local clinic does not offer such a service, you can just as easily go to a regular massage parlor to reap similar benefits.
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   Get support. Living with chronic headaches, no matter their severity, is unpleasant. You might begin to feel worn down, depressed, and defeated. Talk to your family and friends about your condition in order to help them understand what you’re going through. Unburdening yourself in this way might improve your mood and energy levels.

   • Check out chronic migraine or headache support groups in your area. It often helps to talk to others who are experiencing the same thing you are.
   • Get counselling if your headaches are severe and lead to deep anxiety, anger, or depression. A trained therapist can help you find positive ways to cope with these feelings.
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   Take it easy. Stress is one of the most common headache triggers. If you have chronic headaches, rest can help you relieve your pain. Spend extra time in bed reading a book, watching TV, listening to podcasts, or engaging in activities you enjoy (if possible). If your chronic headaches are truly disabling, cut back on your hours at work and ask family members to take on additional household chores for you.
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