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6Jul

Headaches aren’t unusual; we all get them from time to time. But almost 10 percent of U.S. adults will have at least one headache each year so bad that they will end up to the doctor. As many as 6 percent of men and 18 percent of women suffer from migraines every year; a serious and difficult to treat condition.

In a study among people who suffer from migraines, over 40 percent were mistakenly convinced that problems with their sinuses were behind their attacks. An equal number reported having received a misdiagnosis by their physician. A large number of chronic headache sufferers have resorted to decongestants and antibiotics, with no result, or even underwent unneeded sinus surgery.

It has also been shown that over 50 percent of people with migraines try to manage their conditions without consulting with their physician. This may also explain why only 20 percent of migraine sufferers with serious and persistent problems take preventive medications to help manage them.

On the other side, a lot of people fall victims of over medication, where the overexposure to pain-treating drugs multiplies the incidence of headaches and diminishes the medicines’ effectiveness. A 2010 survey revealed that almost 25 percent of people chronically suffering from daily headaches relied on their pain drugs every single day. However, over medication might be the cause of up to 50 percent of headache cases of this kind.

In order to find effective prevention and treatment measures, it’s essential to define the type and cause of a headache. Up to 90 percent of all diagnosed headaches are considered primary, meaning that they occur in the sensory and pain-conducting systems of the brain.

Headaches may also signify another latent problem, such as poor (or too little) sleep, bad eating habits or stress. More serious issues may also be their cause, such as high blood pressure, depression, an acute infection of the sinuses, a sleep disorder or, less frequently, a tumor, a brain infection, or a stroke. Consultation with a physician is recommended if you experience headache attacks more often than 10 days a month, if they are accompanied by other symptoms of neurological nature, or if the attacks get worse with time. Pay attention to signs of danger. Immediate medical help must be sought if a headache:

  • Is sudden and severe.
  • You are having for the first time, and it lasts more than ll days.
  • Came after an injury on the head elsewhere.
  • Appears after you exert yourself.
  • Is the worst headache you’ve ever experienced.
  • Is also accompanied by fever, vomiting, stiff neck, imbalance, speech or vision alterations, or weakness or numbness on one side of your body.

Thwarting headaches

Monitor each episode and try to see if it associates to anything you ate or drunk, the way you slept, or any other events. (You can download a headache diary template for free from the American Headache Society.) Here’s what else you can do to prevent or ease a headache:

Manage triggers that can’t be avoided

Wear tinted glasses, there are some kinds you can wear to limit the effects of bright lighting. Another cool feature I found was the different technology in glass that is available to people suffering from migraine, you can try an interactive tool here and at the bottom of the page you can see how different glasses would look without trying them on. Women who suffer from migraines associated with their period cycles may get help from taking medications in advance and during their cycle. These include over-the-counter ibuprofen (Advil, Motrin IB, or generic) and the prescription medication sumatriptan (Imitrex and generic).

Make simple changes

Limit your alcohol and caloric intake, and use stress-controlling techniques such as relaxation, meditation or other to prevent some of your headaches. If inadequate sleep is what’s causing the problem, try to get 6-8 hours every night. Keep the same sleeping and waking hours and limit your screen exposure before getting to bed (TV, computer or mobile devices). If you have a snoring problem, consult with your doctor about getting a sleep apnea evaluation.

Consider non-pharmaceutical therapies.

In a study that took place in Sweden and was published in September 2011, 91 migraine sufferers were randomly allocated to three different groups. The first group followed a 40-minute stationary bike exercise regimen, three days a week, for 90 days. The second group took a weekly class on relaxation techniques and practiced them at home daily. The third group was put on a daily topiramate regimen (Topamax and generic), an epilepsy-treating drug that’s also used at lower doses to treat migraines. The study showed that exercise and relaxation were as effective as topiramate in reducing the frequency and severity of migraines, minus the side effects.

Some people try acupuncture as well, but research findings have been inconsistent. It was suggested by a 2009 review of 22 studies that it might be slightly better in preventing migraines than beta-blockers; however, traditional acupuncture and “sham” acupuncture (a mock procedure where needles are inserted randomly or not at all) were proven to be equally effective.

Preventive drugs

First line agents that are mostly preferred are beta-blockers like propranolol (Inderal and generic) and timolol (Blocadren and generic) because they are cheap and have a proven safety record. Their adverse effects include tiredness and fainting due to the drop in blood pressure.

Tricyclic antidepressants like amitriptyline (Elavil and generic) are often used. Their common adverse effects are sedation, dry mouth, and weight gain

Other available alternatives are topiramate (Topamax & generic) and valproate (Depakote & generic), both antiepileptic drugs. However, no evidence exists that they work better than the previously mentioned categories, whereas their adverse effects include nausea, tremors, vertigo, and hair loss, and more rarely tongue-swelling, organ damage, and suicidal ideation.

Botox injections were recently given the green light by the Food and Drug Administration to help prevent migraines in adults who experience 15 or more headaches a month for at least three months. This expensive treatment entails 30 to 40 injections in the neck, temples and forehead every three months. Still, it was shown in a few clinical trials that this method is not superior to placebo. Also, another study implied that only certain migraine types may be susceptible to this treatment, namely those who have a focal point behind the eye or the ones causing gripping pain, and not those where the pain is explosive.

Finally, some small clinical trials revealed that many nutritional supplements were effective in reducing the frequency and severity of migraines. These include coenzyme Q10, butterbur, feverfew, riboflavin (vitamin B2) and magnesium. If you want to give these a shot, choose a “USP Verified” provider as recognized by the corresponding mark. This will be indicative that the manufacturer is compliant with the criteria laid by the U.S. Pharmacopeia, regarding the purity, quality and potency of the product and its components.

Dealing with migraines

For attacks of mild to moderate intensity, combining caffeine, acetaminophen and aspirin (Excedrin Migraine and generic) can be as effective as prescription medicines for many sufferers. Nonsteroidal anti-inflammatory drugs (NSAIDs) like naproxen (Aleve and generic) or ibuprofen (Advil, Motrin IB, and generic) can also work well.

If those don’t work for you, you can try one of the triptans, which are prescription migraine drugs. They have fewer adverse effects that other available prescription medicines and seven of them have been approved by the FDA for certain migraine types.

Sumatriptan (Imitrex and generic) is the only drug in this category with generic availability and ofcourse cheaper than branded triptans. It has been shown that its effectiveness is comparable to that of other triptans. Generically available sumatriptan comes also as an injectable and a nasal formulation. The latter two have a faster onset than tablets, and can be particularly helpful if migraines come with vomiting.

Rizatriptan (Maxalt) has the benefit of acting faster than most other drugs in its class, within 2 hours. It costs more than generic sumatriptan, but it may be a more suitable choice if sumatriptan doesn’t deliver in your case.

To get the most out of triptans, you should take them as soon as you realize an attack is imminent. However, almost 30 percent of migraine sufferers won’t find relief in triptans. Only trial and error can reveal which option really works. Combining them with a NSAID might boost their efficacy. There is the possibility of annoying adverse effects with all triptans, such as fatigue, dizziness, numbness, flushing, and tingling. Moreover, there have been rare reports of heart attacks, heart rhythm disturbances of grave severity, strokes, and death. Avoid using them if you are a smoker, obese, you have diabetes, coronary disease, peripheral vascular disease or a history of stroke or heart attack.

Butalpital-containing combination drugs (Fiorinal, Fioricet, and generic) have no clinical evidence backing them for their use in migraines and are burdened by overuse and dependence issues. Adverse effects associated with opioids include drowsiness, nausea, and constipation. Frequent use may lead to dependence and headaches from medicines overuse. Only consider opioid medications if you can’t tolerate triptans or they’ve proven ineffective to you.

Over medication

To keep safe from over medication headaches, use the lowest effective dose and log your drug use frequency. You are risking over medication when you rely on your pain medicine for more than 10 days each month. If find that pain drugs don’t work as well as they used to for you, take it as a warning.

Overuse headaches, also called rebound headaches, are more common with some drugs than with others. The highest risk comes with butalbital and opioids, followed by triptans and OTC analgesics. If you feel you are over medicating, slowly reduce your painkiller consumption. You can help the process with a headache prevention drug.

For most people, the treatment for over medication is successful. But almost 50 percent suffer a relapse within 5 years, so you need to be always vigilant.

Headache triggers

There are things that are believed to cause various types of headaches (tension, migraines or cluster) so avoiding them might help. Such triggers are alcohol; certain foods (aged cheeses or chocolate); bright sunlight or artificial light; stress; poor sleep or lack of it.

  

Dr Felix is a UK based online doctor and pharmacy service that offers convenient online consultations with doctors and home delivery service of your medication.

One Response to Different Headache Types Require Different Treatment

  1. Kirsty Rogers

    Thank you for this advice as I’m seeing a neurologist in June as my migraines have become so much worse than they were 1 yr ago…I’m taking topiramte and acetazolomide twice a day but the topiramte no longer seems to be helping me…I have frequent falls because of the pain and pressure in my head…I’ve been told that I become vacant and none responsive at times….I’m also not allowed to go out alone incase I have a migraine attack as I can not function so I really do need the help I’m hoping the new neurologist will be able to help me…

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