Headache Solutions in Modern Medicine

A few weeks ago I wrote about the naturopathic approach to taming painful headaches (Daily Health News, November 2, 2006  bottomlinesecrets.com/h/7MDB/SL62/KI/EKIAB', but what about advice for those who choose to take the mainstream route? I know far too many people who continue to take over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs) and other pain relievers quite regularly despite all the warnings of painful and sometimes dire health risks as a result of frequent and excessive usage. What are the safest options for my "pill popping" friends? For recommendations, I turned to Robert B. Daroff, MD, professor and chair of the department of neurology at the Case Western Reserve University School of Medicine in Cleveland, Ohio, and past president of the American Headache Society. We talked about the two most common types of headache - tension and migraine -- and what you can do about them.

THE TENSION HEADACHE

Nearly everyone gets a headache from time to time, and often it's a tension headache, observes Dr. Daroff. (He states, however, that the approved official terminology is now "tension-type" headache.) These headaches, which tend to be sparked by stress, anger, anxiety and fatigue, are characterized by mild to moderate, non-pulsating bilateral pain (pain on both sides of the head). Sometimes there is also tightness, like a band wrapping around the head. The pain may begin in the front of the head or back of the neck, and may spread to involve the whole head.

To ease occasional tension headache pain, Dr. Daroff does recommend over-the-counter analgesics (pain relievers) such as aspirin, acetaminophen (Tylenol) or NSAIDs such as ibuprofen (Advil, Motrin, etc.). However, he cautions that using analgesics too frequently can backfire and lead to even more headaches called "rebound headaches." What is too frequently?

If you take medications to relieve even mild tension headaches more than three times a week, chances are you're taking too many over-the-counter remedies, says Dr. Daroff. He points out that many doctors are satisfied with their patients taking daily analgesics, when this is actually a serious mistake. Overuse of OTC pain relievers can lead to rebound or chronic daily headaches that require even more medication, and more seriously, risk of liver, kidney or stomach damage.

WHAT YOU CAN DO

If you suffer from frequent tension headaches -- even if they are mild -- Dr. Daroff recommends that you consult your physician or visit a headache clinic. There are prophylactic (preventive) pharmaceutical medicines available to block or ease tension headaches. In particular, Dr. Daroff recommends low-dose tricyclic antidepressants such as amitriptyline (Elavil), which at lower doses usually do not cause the same uncomfortable side effects (dry mouth, constipation, sexual dysfunction, blurred vision, dizziness, etc.) as do the regular doses for depression. For mild tension headaches, massaging the head and neck may also be beneficial.

MIGRAINE HEADACHES

In contrast to tension headaches, migraines usually affect only one side of the head and the pain has a distinct pulsating quality. These pounding headaches are often accompanied by nausea, vomiting, sensitivity to light and sound, and the pain worsens with routine physical activity. A migraine lasts on average four to 72 hours, and may be preceded by an "aura" or visual disturbance, such as a flash of bright spots or blinking lights.

The trick with migraines is to nip them in the bud, says Dr. Daroff. He warns that once the pain takes hold, it is difficult to subdue. To control an occasional mild migraine, use OTC remedies such as those mentioned above or specific migraine preparations like Excedrin Migraine, which combines aspirin, acetaminophen and caffeine. For more frequent or severe migraines, Dr. Daroff recommends more powerful prescription triptan drugs -- sumatriptan (Imitrex), rizatriptan (Maxalt), naratriptan (Amerge), zolmitriptan (Zomig), almotriptan (Axert), frovatriptan (Frova) and eletriptan (Relpax). (Caution: Do not take triptans if you have had or are at risk of having a heart attack or stroke.)

If you experience two or more migraine attacks per month, or when triptans do not provide adequate relief, your physician may also prescribe preventive medication. Drugs to prevent migraines include, among others, the beta-blockers propranolol (Inderal) and timolol (Blocadren), the antiepileptic drugs divalproex (Depakote) and topiramate (Topamax) and the tricyclics mentioned with tension headache. Generally speaking, beta-blockers -- usually prescribed to treat high blood pressure and cardiovascular disease -- have been on the market longer and have a better track record for safety.

THE MIGRAINE HEADACHE DILEMMA: UNDERDIAGNOSIS

Until he finally consulted a headache specialist, a friend of mine went undiagnosed with migraines for years, because he experienced no auras preceding them. According to Dr. Daroff, this is far from an unusual occurrence, and as many as half of all people with migraines remain undiagnosed or improperly diagnosed. He points out that there is no evidence that "sinus headache" -- a frequent misdiagnosis -- even exists in the absence of acute sinusitis with pain, thick nasal discharge and fever. And, there is no evidence that chronic sinusitis is a cause of headache, says Dr. Daroff. The problem is that when a migraine is not diagnosed or is diagnosed improperly, it will not be treated properly, notes Dr. Daroff.

WHAT YOU CAN DO

If you have regular headaches that your physician diagnoses as sinus or NOS (not otherwise specified), ask for a referral to a neurologist who specializes in headache pain. Most likely you are suffering from a migraine, and a correct diagnosis is the first step to getting well, emphasizes Dr. Daroff. New medications are introduced every year to control migraine and other headaches, and chances are the right one is waiting out there for you.

Drugs aside, Dr. Daroff points out that it is also useful to identify and eliminate possible triggers of migraines. Food triggers -- especially red wine and chocolate -- are especially common. Other possible culprits include aged cheese, nitrates (found in processed meat such as hot dogs and bacon), aspartame, beer, bananas, smoked fish, cured meat and Brewer's yeast.

NO NEED TO SUFFER

Whether you embrace the naturopathic or mainstream approach, there are clearly many solutions available and there's no need to suffer. There are many treatment options available depending on your specific issues. Your best bet for beating persistent headache pain may well be an integrative approach that incorporates the best of all health-care worlds.

 

Be well, Carole Jackson; Bottom Line's Daily Health News; bottomlinesecrets.com

Sources: Modern Medicine's Headache Solutions; Robert B. Daroff, Jr., MD, professor and chair of the department of neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio. Dr. Daroff is past president of the American Headache Society.