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Headaches can’t be cured, but they can be treated

By Jeremy Cockerill | December 1, 2009

Source: Staten Island Advance

Medications, as well as biofeedback, acupuncture and certain vitamins and herbs can help symptoms

In last week’s article I defined the different types of headaches and explained some of the causes. Today, I will talk about the treatment of headaches, based on their cause and type.

Patients with brain aneurysms, strokes, infections, or brain tumors need to have the underlying process treated. The brain in itself is relatively insensitive to pain. Most headaches occur because of the structures around the brain, such as the sinuses or the coverings of the brain.

Billions of dollars are spent yearly on the treatment of patients with primary headaches. Tension headaches are often treated with over-the-counter medications with mixed results.

The type of treatments for patients with headaches is based on two therapies. One of which is prophylactic therapy and includes medications, both pharmacological and non-pharmacological, that patients can take to reduce the number of headaches, such as cluster, migraine or tension-type headaches. They include medications that have been looked at for other disorders.

Anti-sezure medicines, such as Topiramate, Gabapentin, and Valproic Acid have been shown to reduce the frequency of migraine headaches. Blood pressure medications, such as Inderal, can also reduce headache frequency. These medicines are used when patients with chronic migraine-type headaches have episodes frequently enough to affect their lifestyle. These agents help to reduce the number of headaches and actually make other agents, which treat the acute headache work better.

NON-PHARMACOLOGICAL

Non-pharmacological treatments for headaches include the use of biofeedback, relaxation techniques, acupuncture, other rehabilitative medicine therapies and certain vitamins and herbs. Riboflavin, magnesium and the herb feverfew can reduce migraine headache frequency and severity.

The most common treatment for headache disorders is that of abortive therapy. Abortive therapy improves or stops the headaches. In the early 1990s, a class of medication called “triptans” (such as Imitrex) came on the market. These medications increase the effect the brain chemical serotonin. These medicines allow patients to continue to function. Most patients on these medications do not lose work or become very tired from taking sedative agents.

There are side effects with the triptans, including the possibility of chest pain, which may rarely be related to heart or coronary artery problems. In young women, these drugs are especially safe and effective in reducing the headache severity and length of time that patients have headaches. These medicines are helpful for headache, nausea, vomiting and sensitivity to light.

Other agents used for migraine headaches include anti-inflammatory agents, such as Naprosyn and Ibuprofen. OTC agents, such as Tylenol, work dramatically well in some patients. If, however, these common agents are not working well, then other agents should be considered.

OTHER AGENTS

It is all too common for patients to suffer from headaches that are not fully treated with the agents that we have available today. Other treatments that are now being considered for headache disorders include the use of both botulinum toxin, which has shown to be effective in patients who do not do well with other therapies.

People should avoid caffeine-containing medication and should not combine medications such as Fiorcet and Excedrin Migraine. These agents can transform migraine headache into chronic daily headaches, which are often more difficult to treat.

There have been new and exciting advances in the understanding and treatment of headaches over the last few years. It is crucial for patients to discuss with their doctors headache symptoms in order to be diagnosed and treated properly.

This column is provided by the Richmond County Medical Society. Dr. Perel is the immediate past-president of the Society, and Chief of Neurology at Richmond University Medical Center. He maintains a practice in New Dorp.