Headaches

The improved understanding of the physiologic mechanism behind migraine has led to the development of drugs that target the chemicals implicated in those attacks. And the growing realization that all headaches have real neurological mechanisms has prompted headache experts to urge that patients and doctors alike take the condition more seriously and treat it more aggressively. Unfortunately, many people who suffer frequent, debilitating headaches still fail to tell their doctor, while many doctors still fail to prescribe the new treatments-- and in many cases, any effective treatment at all.

The new notion that tension-type headaches, migraines, and possibly cluster headaches are different manifestations of the same basic cause-and that many headaches are hard to classify even based on symptoms-has encouraged doctors to choose treatments based more on severity than on the supposed type. It has also encouraged them to take a more pragmatic, “whatever works” approach than they did before. Many of the same basic treatment options are appropriate for all headache sufferers, however, the overuse of any of those medications can cause dependency, in which chronic headaches persist despite the drugs and worsen when the drugs wear off.

• Massaging the neck and lower rear of the skull can sometimes help relieve mild-to-moderate headaches, perhaps by blocking the transmission of pain signals through the nerves. Ice packs applied there or to the scalp may further ease the pain, by reducing inflammation. Heat packs may also help, perhaps by soothing the overly sensitive nerves. Sitting or lying down and possibly avoiding light and noise.
• Drug choices range from over-the-counter analgesics to the powerful, relatively new “triptans” like Imitrex and Maxalt that target the nerve chemicals that cause inflammation and sensitivity. The body sometimes adapts to headache drugs, making them less effective, particularly when taken too often. To compensate, people often take more pills more often, particularly likely when people can get the drug without a prescription.. But researchers now believe that excessive pill popping can change the brain’s chemistry, interfering with its own pain-fighting mechanisms and, worse yet, causing an ongoing headache on top of the original one. Moreover, over-users can become physically addicted; when the drug wears off they suffer particularly severe headaches, a symptom of withdrawal. Such “rebound” headaches-a term for both the ongoing and the withdrawal headaches-are especially likely to stem from the overuse of triptans, barbituarates, narcotics, and medications containing caffeine. To help avoid such dependency, don’t take headache-treatment drugs more than two or three times per week.
• Individuals who consume lots of coffee, tea, or certain soft drinks can also become addicted to the caffeine and develop withdrawal headaches when they miss their habitual dose. (That’s why heavy coffee drinkers often have a headache until their first cup of the day or on the weekend if they sleep late)
• Over-the-counter products such as Motrin Migraine Pain, Advil Migraine, and Excedrin Migraine are actually identical to the corresponding regular versions that don’t mention headaches. The new boxes were required by the U.S. Food and Drug Administration, which wanted special boxes with special warnings that people should not take such over-the-counter pain relievers to treat migraine without consulting their physician first. While the migraine and regular products generally cost the same, you can save money by buying generic versions.
• The multitude of alternative therapies sometimes recommended for headaches, ranges from herbs and homeopathic remedies to acupuncture and massage.