Treatment

Treatment for an underlying condition often stops frequent headaches. If no such condition is found, treatment focuses on preventing pain.

Prevention strategies vary, depending on the type of headache you have and whether medication overuse is contributing to your headaches. If you're taking pain relievers more than three days a week, the first step might be to wean yourself off these drugs with your doctor's guidance.

When you're ready to begin preventive therapy, your doctor may recommend:

• Antidepressants. Tricyclic antidepressants — such as nortriptyline (Pamelor) — can be used to treat chronic headaches. These medications can also help treat the depression, anxiety and sleep disturbances that often accompany chronic daily headaches.

  Other antidepressants, such as the selective serotonin reuptake inhibitor (SSRI) fluoxetine (Prozac, Sarafem, others), might help in treating depression and anxiety, but have not been shown to be more effective than placebo for headaches.

• Beta blockers. These drugs, commonly used to treat high blood pressure, are also a mainstay for preventing episodic migraines. These include atenolol (Tenormin), metoprolol (Lopressor, Toprol-XL) and propranolol (Inderal, Innopran XL).
• Anti-seizure medications. Some anti-seizure drugs seem to prevent migraines and might be used to prevent chronic daily headaches, as well. Options include topiramate (Topamax, Qudexy XR, others), divalproex sodium (Depakote) and gabapentin (Neurontin, Gralise).
• NSAIDs. Prescription nonsteroidal anti-inflammatory drugs — such as naproxen sodium (Anaprox, Naprelan) — might be helpful, especially if you're withdrawing from other pain relievers. They can also be used periodically when the headache is more severe.
• Botulinum toxin. OnabotulinumtoxinA (Botox) injections provide relief for some people and might be a viable option for people who don't tolerate daily medication well. Botox would most likely be considered if the headaches have features of chronic migraines.

The use of one drug is preferred, but if one drug doesn't work well enough, your doctor might consider combining drugs.