Episodic to Chronic Headaches

Why are my headaches now daily?

There are several risk factors that put the headache patient at risk for exacerbation. Many of these risk factors are modifiable and some are not such as genetic predisposition.

Modifiable risk factors:

  • Medication overuse – primarily combination analgesics combined with caffeine (over-the-counter or prescription), Caffeine, Ergotamine, Opiates, Over-the counter or prescribed analgesics, and Triptans. All these medications can be effective in treating episodic headache when used on an occasional basis. However, when used more than two days a week, they may transform and aggravate headache.
  • Stress – Stress is the most common trigger for headache in headache sufferers. Frequent life changes and chronic daily stressors or “hassles” can lead to the development of chronic headaches. These stressors may also result in anxiety and depression.


  • Sleep disturbance – Chronic inadequate sleep of approximately 6 hours or less per night creates risk for more headaches. Most common sleep problem for headache patients is insomnia (trouble falling asleep, staying asleep, or poor quality sleep).



  • Obesity – Obesity increases headache frequency. A person with a BMI > 30 is considered obese or waist >35 inches in a woman and >40 inches in a man



  • Caffeine – Caffeine can aggravate headaches the same way medication overuse can. Frequent use of caffeine can also be a risk factor for headache progression. Caffeine is added to certain pain medications because it can be beneficial for migraine when used occasionally and in moderation, defined ideally as two days per week or less.


An understanding of the specific causes or contributing factors that lead to progression, and then reversing them, is key to successful treatment. Please call us for a consultation if your headaches have transformed from episodic to daily.

By: Tanesha Reynolds, DNP, FNP, BC in Headache Medicine