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Health condition · Clinically reviewed

Chronic daily headaches, from red flags to Botox, CGRP and calm days again.

Fifteen or more headache days a month is not something you have to live with. A structured pathway finds the cause, addresses medication overuse and matches you with the right modern treatment.

Jump to treatment
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a UK neurologist before publication.

  • 02

    Sourced from guidance

    Checked against NICE, BASH, IHS and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice including CGRP monoclonal antibodies, gepants and Botox for chronic migraine.

Key facts

Chronic daily headaches at a glance.

The essentials, in plain English, what CDH means, how it splits into primary and secondary causes, and the modern treatments UK clinics use.

  • What it is

    Headache on 15 or more days per month for at least 3 months, split into primary and secondary causes.

  • Primary CDH

    Chronic migraine, chronic tension-type headache, new daily persistent headache and hemicrania continua.

  • Medication overuse

    A major and often unrecognised driver, analgesics 15+ days per month or triptans, opioids or combinations 10+ per month.

  • Red-flag screening

    The SNOOP10 framework helps flag features that need urgent imaging or specialist review.

  • Preventatives

    Amitriptyline, propranolol, topiramate, candesartan and, for chronic migraine, Botox and CGRP monoclonal antibodies.

  • Hemicrania continua

    Continuous unilateral pain with autonomic features, absolute response to indomethacin is both diagnostic and treatment.

Why this guide matters

A pathway, not another packet of pills.

Chronic daily headache is common, treatable and often mislabelled. The three ideas below shape everything else on this page.

  • Phenotype first

    Chronic migraine, chronic TTH, NDPH and hemicrania continua all need different treatments, so an accurate diagnosis matters more than any single drug.

  • Medication overuse is fixable

    One of the largest and most reversible drivers of daily headache, spotted and treated by structured withdrawal with specialist support.

  • Modern preventatives exist

    Botox, CGRP monoclonal antibodies and gepants have transformed outcomes for chronic migraine on the NHS and privately.

How the diagnosis is made

From a busy history to a clear plan.

The steps a UK GP, neurologist or headache clinic will normally follow, in order, so you know what to expect and why.

  1. 01

    Assessing

    Structured history and diary

    Frequency, pattern, triggers, medication use, sleep, mood, trauma and psychosocial context, alongside a 4-8 week headache diary.

  2. 02

    Assessing

    Full examination

    Blood pressure, cranial nerves, fundoscopy for papilloedema, temporal artery palpation, neck movement and TMJ assessment.

  3. 03

    Assessing

    Screen for SNOOP10 red flags

    Systemic, neurological, sudden onset, older age, progressive pattern, Valsalva-triggered, papilloedema, postural and painkiller-overuse features.

  4. 04

    Confirming

    MRI brain when indicated

    For red flags or atypical features, to exclude tumour, stroke, CSF leak and other structural causes.

  5. 05

    Confirming

    MR venogram and lumbar puncture

    MRV for suspected IIH or cerebral venous sinus thrombosis, LP with opening pressure for IIH, CSF leak and suspected meningitis.

  6. 06

    Confirming

    Bloods and sleep review

    ESR and CRP if giant cell arteritis is possible, medication review, and polysomnography if sleep apnoea is suspected.

  7. 07

    Preparing

    Specialist headache pathway

    Referral to neurology or a headache clinic for phenotyping, medication overuse withdrawal and access to Botox, CGRP therapy and nerve blocks.

Typical timeline: first visit to a settled plan in weeks, with preventative benefit judged over 8-12 weeks.

Types and features

What chronic daily headache looks like.

Primary chronic headaches, common secondary causes and the features that mean it is time to escalate to imaging or specialist care.

  • Chronic migraine

    Headache 15+ days per month with 8+ migrainous days, often with nausea, photophobia and phonophobia. See our migraine guide.

  • Chronic tension-type headache

    Bilateral, pressing or tightening pain on 15+ days per month, usually without nausea or disabling severity.

  • New daily persistent headache

    Abrupt onset of continuous daily headache from a clearly remembered date, often in previously headache-free people.

  • Hemicrania continua

    Continuous strictly unilateral pain with autonomic features, defined by an absolute response to indomethacin.

  • Medication overuse headache

    Daily or near-daily headache in people using acute painkillers, triptans, opioids or combinations too frequently.

  • Post-traumatic headache

    Daily headache beginning within 7 days of head or neck injury, can persist for months and mimic migraine or TTH.

  • Cervicogenic and TMJ headache

    Neck or jaw dysfunction referring pain to the head, reproduced by neck movement or jaw loading.

  • Red flag - thunderclap or new deficit

    Sudden severe headache, new neurological signs, papilloedema or systemic illness need urgent assessment.

Treatment

How chronic daily headache is treated in the UK.

Withdraw medication overuse, choose the right preventative for the phenotype, layer in nerve blocks, Botox, CGRP therapy or neuromodulation when needed, and support with lifestyle, mental health and non-drug care.

  • Stop medication overuse

    Identify and gradually withdraw overused analgesics, triptans, opioids or combinations, often with specialist support. Expect a 2-4 week worsening before improvement.

  • Amitriptyline

    Tricyclic 10-75 mg at night, first-line preventative for chronic TTH and often useful in mixed chronic daily headache.

  • Propranolol or metoprolol

    Beta-blockers with strong evidence for migraine prevention, avoided in asthma and used with care in low mood.

  • Topiramate

    25-100 mg twice daily, evidence-based for chronic migraine, watch for cognitive effects, weight loss and pregnancy considerations.

  • Sodium valproate

    An option for males and non-pregnant patients under strict pregnancy prevention rules, effective in migraine prevention.

  • Candesartan

    An angiotensin receptor blocker with a growing evidence base for migraine prevention when other agents are unsuitable.

  • Botulinum toxin A (Botox)

    NICE-approved for chronic migraine with 15+ headache days and 8+ migrainous days, given per PREEMPT protocol at 155-195 units.

  • CGRP monoclonal antibodies

    Erenumab, fremanezumab, galcanezumab and eptinezumab, monthly SC or quarterly IV, NICE-approved after failed oral prophylactics.

  • Gepants

    Rimegeneral (Vydura) for acute and preventive use, ubrogepant and atogepant offer oral CGRP receptor antagonism.

  • Indomethacin trial

    A structured 150-300 mg indomethacin trial confirms and treats hemicrania continua, response is typically complete.

  • Nerve blocks

    Greater occipital and supraorbital nerve blocks in a headache clinic, useful in chronic migraine, cervicogenic and NDPH.

  • Neuromodulation devices

    Transcutaneous supraorbital (Cefaly), non-invasive vagus (gammaCore) and remote electrical (Nerivio) devices under specialist advice.

Beyond medication

Non-drug care, MDT and comorbidity matter as much as prescriptions.

Sleep hygiene, regular meals, hydration, moderated caffeine, exercise and weight management reduce headache days. CBT, biofeedback, mindfulness, acupuncture, physiotherapy and posture work all have evidence. IIH benefits from weight loss, acetazolamide and selected neurosurgery. Coexisting depression, anxiety and PTSD are common and should be treated in parallel through the neurology and headache MDT, alongside UK specialist centres such as the National Hospital for Neurology, King's, Manchester and Sheffield.

What this guide is based on

The sources behind every claim on this page.

UK national guidance, IHS classification and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP, neurologist or headache clinic knows your history and can tell you which parts of this apply to you. If in doubt, get seen.

  • NICE. Headaches in over 12s: diagnosis and management (CG150).

  • NICE technology appraisals for erenumab, fremanezumab, galcanezumab, eptinezumab and rimegepant in chronic migraine.

  • International Headache Society (IHS). International Classification of Headache Disorders, 3rd edition (ICHD-3).

  • British Association for the Study of Headache (BASH). National headache management guidelines.

  • The Migraine Trust. Patient information on chronic migraine and medication overuse headache.

Red flags · SNOOP10

When headache needs urgent attention.

Most chronic daily headache is manageable in primary care and a headache clinic. These features are not, and change the pathway.

  • Thunderclap headache

    Sudden severe headache peaking within seconds needs urgent imaging to exclude subarachnoid haemorrhage and other vascular causes.

  • New neurological deficit

    Weakness, sensory loss, speech disturbance, visual field defect or ataxia alongside headache needs same-day assessment.

  • Papilloedema or visual obscurations

    Suggests raised intracranial pressure, including idiopathic intracranial hypertension or a space-occupying lesion.

  • Postural or Valsalva-triggered pain

    Positional headache can indicate CSF leak or low pressure, cough-related headache can suggest Chiari or posterior fossa disease.

  • Older age with new headache

    New headache after age 50, especially with jaw claudication or visual loss, needs urgent GCA screening with ESR and CRP.

  • Systemic features

    Fever, weight loss, night sweats, immunocompromise or cancer history raise concern for infection, malignancy or vasculitis.

  • Progressive pattern change

    A steadily worsening or clearly changed headache pattern deserves imaging and specialist review.

  • Painkiller overuse

    Suspect medication overuse headache in anyone using acute analgesics on more days than not, this is a treatable major driver.

  • Pregnancy or postpartum

    New severe headache in pregnancy or the postpartum period needs urgent review to exclude pre-eclampsia, CVST and PRES.

Living with it

Fewer headache days, calmer weeks.

Four things that make the biggest difference day to day, a steady rhythm, an honest diary, mind-body work, and asking for specialist help sooner than you think.

A quiet reminder

Progress is a trend line, not a single day.

Judge preventative treatment over 8-12 weeks and a full diary cycle, not over one bad afternoon.

  1. 01 Rhythm

    Anchor your day

    Regular sleep, meals, hydration and movement flatten the peaks and troughs that trigger headache.

  2. 02 Diary

    Track before you treat

    A 4-8 week headache diary reveals patterns, overuse and true response to preventatives more honestly than memory.

  3. 03 Mind

    Mind and body together

    CBT, mindfulness, biofeedback and paced physiotherapy meaningfully reduce headache days alongside medication.

  4. 04 Escalate

    Ask for specialist help

    If you have 15+ headache days a month or medication overuse, a headache clinic can access Botox, CGRP therapy and nerve blocks.

Frequently asked

Everything we get asked about chronic daily headaches.

Quick answers on definitions, medication overuse, imaging, preventatives and modern options like Botox and CGRP therapy.

  • What counts as chronic daily headache?

    Headache on 15 or more days per month for at least 3 months. It is an umbrella term that covers primary causes such as chronic migraine, chronic tension-type headache, new daily persistent headache and hemicrania continua, as well as secondary causes such as medication overuse, raised intracranial pressure, post-traumatic headache and cervicogenic headache.

  • Could my painkillers be making it worse?

    Yes. Medication overuse headache is one of the most common and least recognised causes of daily headache. Simple analgesics used on 15 or more days per month, or triptans, opioids or combination analgesics used on 10 or more days per month, can perpetuate headache. Improvement usually needs a supervised withdrawal, and things often feel worse for 2-4 weeks before they get better.

  • When do I need a brain scan?

    A scan is not needed for every headache. MRI is indicated when there are SNOOP10 red flags, atypical features, a new pattern in someone over 50, progressive change, postural headache, papilloedema, focal neurology or a thunderclap presentation. A specialist may also request MR venography and lumbar puncture if idiopathic intracranial hypertension or CSF leak is suspected.

  • What preventative treatments actually work?

    For chronic tension-type headache, amitriptyline is first line. For chronic migraine, options include propranolol, topiramate, candesartan and, in men or non-pregnant women, sodium valproate. If oral preventatives fail, NICE supports botulinum toxin A and CGRP monoclonal antibodies such as erenumab, fremanezumab, galcanezumab and eptinezumab, alongside oral gepants like rimegepant.

  • What is hemicrania continua and why does indomethacin matter?

    Hemicrania continua is a continuous strictly one-sided headache with autonomic features such as tearing, nasal congestion or eyelid drooping. It has a defining feature, an absolute response to indomethacin. A structured indomethacin trial is therefore both the diagnostic test and the long-term treatment, monitored for gastrointestinal and renal side effects.

  • Can lifestyle changes really make a difference?

    Yes. Consistent sleep, regular meals, hydration, moderating caffeine, graded exercise, weight management where relevant, stress reduction, CBT, biofeedback, mindfulness and neck-focused physiotherapy all reduce headache days. They work best combined with the right medical strategy rather than as a substitute for it.

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