Headache Treatment
Headache treatment often depends on the type, the severity, and the frequency of occurrence. In many cases, tension headache can be effectively treated using conservative measures, such as lifestyle modifications (e.g., improvements in diet and sleep patterns) and over-the-counter pain relievers (e.g., acetaminophen, ibuprofen).
Cluster headache and migraine headache may require prescription medications and preventative (prophylactic) treatment.
Tension Headache Occasional tension headache usually can be treated successfully with lifestyle adjustments and over-the-counter analgesics (e.g., aspirin, ibuprofen, acetaminophen). When headaches are severe or frequent, care must be taken to avoid analgesic overuse, which can lead to rebound headaches.
In rebound headache, high levels of the drug in the body actually cause daily headache. In most cases, rebound headaches improve when the medication is stopped.
Tension headaches that resist treatment with over-the-counter agents may be treated with antidepressant or anxiety-reducing medications, such as amitriptyline, nortriptyline or desipramine.
Some tension-headache patients report beneficial results from secondary treatments that help reduce the effects of stress and tension on the body, such as massage, meditation, and biofeedback. When appropriate, psychotherapy may help some patients learn to cope better with stresses that can lead to headache.
Cluster Headache Treating cluster headache involves relieving the severe, sometimes unbearable pain during the headache, and disrupting or shortening the cluster episode. Acute treatment medications are similar to those used for migraine and include:
* Sumatriptan (Imitrex®) – injectable or nasal spray (Other oral triptans may also be effective.)
* DHE (Migranal®) – injectable or nasal spray (May cause nausea and dizziness.)
* 100% oxygen – inhaled from oxygen tank (Oxygen tank can be kept for home use.)
* Narcotics (e.g., codeine) – oral form (May not act quickly enough.)
Prednisone is a corticosteroid, a potent chemical that occurs naturally in the body. It is taken initially in high doses and then tapered over days or weeks, depending on the response. This medication is best if used for short periods of time.
Long-term corticosteroid use can cause many serious adverse side effects because it is involved in several different functions in the body. Potential side effects include an increase in intraocular pressure, osteoporosis, behavioral changes, ulcer, and diabetes.
Lithium carbonate Lithium may increase the levels of dopamine and norepinephrine in the brain. It is taken orally, usually twice a day, to interrupt a cluster headache. Concentration of lithium in the blood is closely monitored with periodic blood tests. Side effects include tremor, increased thirst, nausea, and frequent urination. Lithium carbonate typically is used to treat manic episodes in manic-depressive patients.
Verapamil dilates blood vessels. It can be taken twice daily in a sustained oral preparation. Side effects include nausea, dizziness, and constipation. Verapamil typically is used to treat angina, hypertension, and arrhythmias.
New Headache Treatments
Ongoing research to develop new headache and migraine treatments is focused on providing faster pain relief, reducing drug side effects, and decreasing headache recurrences.
It often takes about 10 to 15 years for a new medication or treatment to receive approval from the U.S. Food and Drug Administration (FDA). Patients who experience migraines or chronic headaches should contact a qualified health care provider to develop an effective course of treatment.
According to the National Headache Foundation (NHF), headache treatments that work quickly, cause few side effects, and are easy to use are currently being developed. These treatments include the following:
* Generic versions of approved drugs (e.g., oral and nasal sumatriptan)
* New delivery methods for approved drugs (e.g., inhalation device, skin patch [also called transdermal patch], nasal powder, nasal spray)
* New indications for approved drugs (i.e., treating headaches and migraine using medications that are approved to treat other medical conditions)
* New medications (e.g., combination of sumatriptan and naproxen)
* New medical procedures and devices (e.g., neurostimulator implantation)
New delivery methods include inhalation devices, which allow the drug to enter the bloodstream faster and may lead to more rapid pain relief, and transdermal patches, which release controlled amounts of medication through the skin, maintaining precise blood levels of the drug. Other treatments that are in development include nasal powders, nasal sprays, and buffered oral medications, which allow pain medication to enter the bloodstream faster and may provide faster pain relief.
Research is ongoing to determine if there is a connection between certain types of headaches and a congenital heart defect called patent foramen ovale (PTO). Before birth, there is a normal opening between the upper chambers of the heart (called the atria) that allows blood flow to bypass the lungs. Usually, this hole closes shortly after birth; however, in about 1 out of every 3 or 4 people, it does not close as it should. When this occurs, the condition is called patent foramen ovale.
If there are no additional heart defects, patent foramen ovale often does not cause symptoms. Some studies have shown that performing surgery to close the hole may reduce the incidence of migraine and cluster headache in patients who have the condition. Further research is necessary to determine the connection between headache and PTO.
Medications used to treat other conditions that are being studied to determine if they can also be used to treat headache and migraine include anticonvulsants (used to treat epilepsy; e.g., Tripleptal®, Neurontin®), olmesartan (an angiotensin II-receptor blocker used to treat high blood pressure; e.g., Benicar®), and donepezil (used to treat Alzheimer’s disease; e.g., Aricept®).
Some drugs that are currently used to treat migraines (e.g., triptans) are being studied regarding menstrual migraine. These medications include frovatriptan (Frova®), rizatriptan (Maxalt®), eletriptan (Relpax®), and butorphanol nasal spray.
Other headache treatments that are being studied include neurostimulation and iontophoresis. Neurostimulation, which is sometimes used to treat other types of chronic pain, may also be used to treat headache. This treatment involves using electrical impulses from an implanted device to interrupt pain signals.
Iontophoresis uses mild electrical current to deliver pain medications. In this treatment, pain medication in an electrically-charged solution is placed on the skin, an electrode is placed over the solution, and a mild current is applied to propel the medication into the skin.
Natural Medicine
What causes headaches? The most common cause of regular headaches is muscle tension caused by spinal misalignment. A simple chiropractic evaluation and adjustment is often all it takes to relieve recurrent headaches.
Paradoxical as it may seem, a surprising percentage of headaches may be caused by headache medication. The “rebound effect” of analgesic and ergotomine compounds has been implicated as a contributing factor for sufferers of daily headaches. Discuss this phenomenon with your prescribing doctor if you are taking more than 30 analgesic tablets a month or if you regularly use ergotamine derivatives. Withdrawal from these products can temporarily make headaches worse, but eliminating these products altogether may ultimately mean far fewer headaches.
How what you eat can give you headaches When exploring the causes of headaches, the easiest place to start is diet. Food reactions are a significant contributor to headaches and some improvement, if not complete remission, can usually be achieved by eliminating problematic dietary items. The elimination/challenge trial is a good way to identify food reactions that may be causing headaches.
Physical medicine Submerge the feet in a bucket of very hot water while at the same time applying an ice compress to the back of the neck. This actually draws the blood down to the feet away from the head. Reduction of pain coincides with the duration of application.
Acupressure type massage can be helpful. See a trained acupressure therapist for instructions on procedures to do at home.
Chiropractic adjustments and maintaining correct spinal alignment can be very supportive in the prevention of headaches that are triggered by muscle stress and spasm.
Acupuncture
Acupuncture is a very useful treatment. It can balance underlying hormonal deficiencies, tonify the gastrointestinal system, and calm reactive blood vessels. It can support the balancing required in any healing process.
A word of caution: when selecting an acupuncturist, be very careful to research the training and qualifications of your practitioner. Medical doctors can take weekend courses in acupuncture and call themselves certified acupuncturists. A weekend course is NOT enough study to understand the complex philosophy or practice of Chinese Medicine.
Choose a practitioner who holds a full doctorate degree in Chinese medicine: an O.M.D. (Oriental Medicine Doctor) or Lic.Ac (licensed acupuncturist). These practitioners are required to complete several years of training. The letters TCM (Traditional Chinese Medicine) after the name means that the doctor has additional training in the prescribing of Chinese herbs. The more knowledge a practitioner has about Chinese Medicine, the better they will be able to diagnose and treat your symptoms. Also, as with all health care practitioners, check the practice reputation in the community.
Your environment and your headaches Headaches can be agonizing and debilitating. The inclination to “make the pain go away now,” however, can be an obstacle to curing the cause of the pain. It is easy to become trapped in a cycle medication and side effects. Headaches do not just happen; they are not a random occurrence. They are your body interacting with the environment. Explore the environment as well as the your body’s relationship to it to determine the factors that are upsetting your internal balance and you can control your headaches and know how to prevent them from re-occurring.
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Stanley J. Swierzewski, III, M.D.
Healthcommunities.com, Inc