Strong Medicine for Stubborn Headaches

Prescription drugs can trump over-the-counter medicines in severe cases

TUESDAY, June 8, 2004 (HealthDayNews) -- You're laid up with a splitting headache -- again. Like most headache sufferers, you've tried various nonprescription pain medications, but nothing seems to bring relief. Now what?

It is probably time for you to call your doctor.

More than 45 million Americans get chronic, recurring headaches, according to the National Headache Foundation. They're a leading cause of absenteeism, costing U.S. industry an estimated $50 billion a year in lost productivity and medical expenses.

For those who suffer frequent or debilitating headaches, relief may seem hopelessly out of reach. But the prognosis actually is quite good.

And that's an insight worth sharing during National Headache Awareness Week, June 6-12.

About 90 percent of chronic headache patients can be helped, according to the National Institute of Neurological Disorders and Stroke.

As a first line of treatment, doctors say, people should try a nonprescription remedy, such as aspirin, ibuprofen, acetaminophen or naproxen sodium. There are specially formulated headache products on the market, too, which combine an analgesic with caffeine to boost the drug's pain-relief potential.

"If over-the-counter medicines work, then great," said Dr. Randall Bateman, a neurologist and senior resident at Washington University School of Medicine in St. Louis. But, he noted, "most people, by the time they see a physician, have tried over-the-counter medications."

What's more, self-medicating can be a tricky business. Aspirin, ibuprofen products (such as Motrin and Advil) and naproxen sodium (sold under the brand name Aleve) belong to a class of medications known as nonsteroidal anti-inflammatory drugs. These drugs are effective for relieving pain and inflammation but also can cause stomach bleeding and ulcers.

And chronic use of analgesics can lead to rebound headaches, Bateman cautioned. They're a type of headache commonly seen among people who take pain relief medicines day in and day out. When the drugs wear off, the headache returns and the person ends up taking more medication. It's a cycle that's difficult to break because the headache is actually caused by the chronic use of these medications, he explained.

For many chronic headache sufferers, prescription remedies provide much better relief.

As a general rule, neurologists say, if you're having headaches more than two or three times a week, you should see a doctor to assess your symptoms. The American Council for Headache Education also recommends you call your doctor if you take a pain reliever daily or almost daily or need more than the recommended dose.

On occasion, headaches can signal more serious problems. If your headaches are worsening or have changed in character or if you have neurological symptoms with your headache, such as weakness, sensory changes or speech defects, you should seek immediate medical attention.

These can be signs of such life-threatening conditions as brain hemorrhage, swelling around the brain, or subdural hematoma (a pool of blood over the surface of the brain), Bateman said.

But even headaches that are benign can be severe enough to interfere with work or school. That's when you know it's time to see a doctor.

Dr. Madeleine Kitaj, a neurologist and director of the Kitaj Headache Center in Southbury, Conn., says physicians used to treat the dull ache of tension headache and the crushing pain of migraine very differently. People were labeled as either tension headache sufferers or migraineurs.

But as the field of headache and pain management evolves, some experts have come to believe these conditions are part of the same continuum, she said.

"Now what we look at is the symptoms of the headache to determine what treatment will work the best," Bateman explained.

Migraine, which affects 28 million Americans, is the most common type of severe, recurring headache. Women are three times more likely than men to suffer migraine, which causes throbbing head pain, usually on one side of the head, and may be accompanied by nausea or sensitivity to light and sound.

In fact, Bateman said, when patients see a doctor for what they call a tension headache, often the symptoms suggest they're actually experiencing migraine.

Migraine treatments run the gamut from drugs and alternative therapies that appear to prevent migraine to medicines that ease the symptoms.

Dr. Alexander Mauskop, director of the New York Headache Center and author of The Headache Alternative: A Neurologist's Guide to Drug-Free Relief, is a big promoter of alternative therapies. He recommends patients try relaxation techniques such as biofeedback, do regular aerobic exercise, and take supplements such as magnesium, riboflavin and the herb feverfew.

He even injects Botox, the U.S. Food and Drug Administration-approved wrinkle fighter, in some patients to prevent migraine.

But he's also a proponent of triptans, a breakthrough class of drugs that cause the blood vessels to constrict and ease painful inflammation of nerve endings in the brain. Studies show these drugs can ease symptoms in more than 80 percent of patients.

"They're very effective -- more effective than any other prescription or over-the-counter drug," Mauskop said.

Triptans may also be effective for treating treat cluster headaches, a rare but severe type of pain that occurs behind one eye and usually lasts a half hour to 45 minutes, according to the American Academy of Family Physicians. These headaches strike men more than women and typically occur about the same time each day for a period of four to eight weeks.

Yet many patients who could benefit from triptans are not receiving them because of safety concerns, according to a consensus statement released by a special panel of the American Headache Society. While triptans have been associated with possible cardiovascular events, the panel believes the risk is far below that seen with nonprescription alternatives.

"Many doctors and family members under-appreciate the effect of migraine on a person, so they treat it just like a headache, which it's not," Mauskop reasoned.

There's another reason why triptans are not as widely used as they might be. Insurance companies often limit the number of pills they'll pay for each month, Kitaj has observed. When patients have reached their limit, they end up relying on other therapies for the rest of the month, she said.

In addition to taking triptans, people who experience severe migraine more than three times a month often can benefit from medicines that lower the number and severity of their attacks, Bateman noted. These include beta blockers, tricyclic antidepressants and anti-epileptic agents.

With the bevy of pharmaceutical, nutritional and alternative treatments available today, chronic headache victims needn't suffer in silence.

"The best advice is at least have a consult so you know what's happening," Kitaj said.

More information

The National Headache Foundation can tell you more about headaches and headache treatment.

SOURCES: Randall Bateman, M.D., neurologist and senior resident, Washington University School of Medicine, St. Louis; Madeleine Kitaj, M.D., neurologist and director, Kitaj Headache Center, Southbury, Conn., and attending physician, Griffin Hospital, Derby, Conn.; Alexander Mauskop, M.D., director and founder, New York Headache Center, New York City, and associate professor, neurology, S.U.N.Y. Downstate Medical Center, Brooklyn, N.Y.
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