This headache never goes away

Dr.  Keith Roach

Dear Dr. Roach: I have suffered from constant headaches for years. I have had an evaluation by a neurologist, with all kinds of X-rays and scans. Who in the medical field deals with headaches that never go away? They may get to a dull ache, but I always know they are there.

— CV

Dear CV: Chronic daily headache is a concern I hear occasionally. In my experience as a primary care doctor, the No. 1 cause is medication overuse for a headache. Most people I have seen with this have had migraines that were treated with short-term pain relief medicines for so long that the body became accustomed to the medication. Anytime the medication is stopped, the pain returns, leading to continuous use and continuous headache. In these cases, the medicine must be stopped, and different types of medications are used to get someone through the process of getting off the medication.

There are other possibilities. Although chronic migraine can cause very frequent headaches, a person with unrelenting migraine is unusual. Similarly, people can have chronic tension headaches but for them never to relent is outside my experience. If the pain were only on one side, the diagnosis could be an unusual condition called “hemicrania continua,” which can be unremitting.

Dr.  Keith Roach

All neurologists have expertise in migraine and other headaches, but some neurologists make headache their sole focus. Seek out a neurologist with special expertise in evaluation and treatment of headaches.

Dear Dr. Roach: My significant other and I are in our 50s, vaccinated and boosted. We have one child under 12 who is fully vaccinated. A close relative, who is against both vaccinations and mask-wearing, is currently sick with COVID-19. The relative has been insisting on being able to visit with us indoors at our home throughout the pandemic. We have always said no. Now this person believes that after their recovery, they will be as protected against coronavirus as a vaccinated person is and are insisting to visit indoors with us on this basis. My significant other and I are not on the same page about this. We have other health conditions and avoid mixing indoors in general.

— Anon.

Dear Anon.: The evidence is clear that a person’s risk of reacquiring COVID-19 is very low in the 30 days following infection. After that, the person begins to have risk again. That risk is even greater if the variant is different from what the person was infected with. As I write this, the omicron variant is the dominant strain, but by the time this column publishes, a new variant may already have emerged, possibly one that is even better at escaping the protection from vaccination or previous infection. Unfortunately, it appears we are going to be living with COVID-19 for the foreseeable future.