Headache Help
Authors: Lawrence Robbins
Table of Contents
Understanding the Modern Approach
Treating Migraines in Progress
Women, Hormones, and Migraines
Treating Tension Headaches in Progress
Understanding and Treating Cluster Headaches
Headaches in Children and Adolescents
Headaches in People Over Fifty
Less Common Headaches and Treatments
Appendix A: Headache-Related Organizations and Publications
Appendix B: Over-the-Counter Headache Medications
Appendix C: Medications and What’s in Them
Copyright © 2000, 1995 by Lawrence Robbins, M.D., and Susan S. Lang
All rights reserved
For information about permission to reproduce selections from this book, write to Permissions, Houghton Mifflin Company, 215 Park Avenue South, New York, New York 10003.
The Library of Congress has cataloged the print edition as follows:
Robbins, Lawrence D.
Headache help : a complete guide to understanding headaches and the medicines that relieve them / Lawrence Robbins and Susan S. Lang.—Rev. and updated,
p. cm.
ISBN
0-618-04436-1
1. Headache—Popular works. I. Lang, Susan S. II. Title.
RB128.R628 2000 616.8'49I—dc21 00-036940
“Headache Calendar” copyright © 1993 by Lawrence Robbins, M.D.,
Management of Headache and Headache Medications
, Springer-Verlag, New York.
Appendix B, “Over-the-Counter Headache Medications,” copyright PDR
for Nonprescription Drugs
®, 1994, 15th edition, and 1999, 20th edition, published by Medical Economics Data, Montvale, New Jersey 07645. Reprinted by permission. All rights reserved.
The information presented in case histories and stories in
Headache Help
is medically accurate. However, all names, places, and identifying characteristics have been changed to protect privacy. Some case histories contain elements from more than one patient. Any resemblance to persons living or dead is coincidental.
e
ISBN
978-0-544-34149-4
v1.0814
For my family
and those suffering
the burden of head pain
—L.D.R.
For Solon J. Lang
—S.S.L.
THE GRIEF OF THE HEAD IS THE GRIEF OF GRIEFS
.
—James Howell,
English Proverbs
, 1659
This book is intended for educational purposes only. Before you start the regimens presented here, consult your own physician to make sure that they are suitable for you. None of the information is intended to substitute for medical advice. If you have any problems or questions related to your health and fitness, you should direct them to your physician.
Visit our Web site,
www.headachedrugs.com
, to keep abreast of the latest headache information. Here you’ll find a vast amount of headache-related material, starting with our links:
What’s New?
Patient’s Corner
Medications
General Advice
Headache Books
Headache Herbs
PREFACE
H
EADACHE
is an extremely common problem that affects tens of millions of people in the United States. As a headache specialist who suffers from migraines and daily headaches myself, I know firsthand the burden that headaches add to one’s life.
In the past ten years, there has been a virtual revolution in the understanding and treatment of headaches. Yet headaches remain largely misunderstood by many physicians and patients alike and, in general, remain a poorly treated condition. Like asthma, shock, epilepsy, and many other medical problems once thought to be caused by stress or emotions, headache is a legitimate physiological medical condition, not a psychological one. People who get headaches do not bring them on themselves but rather have different levels of the brain chemical serotonin and a much greater reactivity of blood vessels about the head than others.
Despite tremendous strides in headache management, enormous amounts of time and money are wasted on useless diagnostic tests and treatments. As a result, headache sufferers, who have been unfairly blamed for their illness for far too long, become angry and frustrated, and many simply give up the search for effective headache therapy.
Many of the books currently available on headaches emphasize nonmedication techniques, which can be very useful but often only up to a point. These books give precious little information about the vast array of effective medications now available. Headache sufferers want to know more about their medications, and they should. Susan Lang and I felt there was a need for a book about the actions and side effects of the drugs that readers may take and the trial and error that is sometimes necessary to find the right medication at the right dose.
That’s why this book places a strong emphasis on drug therapy. Nonmedication techniques are important, and
Headache Help
explores them fully. But for people who suffer severe headaches, these remedies often fall short, and medication becomes the primary key to treatment. Our aim is to provide as much reference material as possible so that lay readers can be better informed.
Headache sufferers should be commended for fighting through life with head pain. We hope the burgeoning knowledge about headaches will lead to more compassion for their suffering. With our new understanding of headaches as a physical problem, we can help the vast majority of patients tremendously with current therapies. If you or a loved one suffers from head pain, you should know all about the options; hence, we give you this book.
A caveat: Although we discuss many medications and treatments for headaches, this information is not meant to be prescriptive, suggestive, or a substitute for the medical advice of a physician. Only a doctor who understands your particular situation can make well-informed decisions about your treatment plan. Similarly, although we offer lists of common or first-line medication choices, there are always exceptions, and your doctor is best equipped to make this judgment.
Our intent is to provide information and education. In most cases, we could present only the common uses and side effects of medications. When you get a prescription, we still recommend that you ask your doctor or your pharmacist for details about possible side effects.
Physicians’ Desk Reference
or the package insert also lists contraindications.
—Lawrence Robbins, M.D.
Northbrook, Illinois
S
OME OF MY VIVID
childhood memories are of my father’s migraines. On bad days, he would retreat into his study, and the house became dark and gloomy. Although we four children tried to remember to stay quiet, we often forgot, and my mother would harshly scold us and banish us from the upstairs rooms. When would Daddy feel better and life resume its normal quality? Why did he have to get these things called migraines and disrupt our lives?
Since those days, my dad has “outgrown” his horrendous headaches, and we’ve emerged from the dark ages of headache treatments. But even the best treatments are useless if they are not sought out or adhered to. Information is empowering and is one of our most effective tools in our quest for better health and well being. As a medical writer, my goal is to provide you with information so that you are not the passive recipient of a doctor’s care, but an active, well-informed consumer.
To address those who may criticize Lawrence Robbins and me for focusing so heavily on medications: We do not minimize the power of mind-body techniques or of more natural therapies. Rather, we believe you should be fully informed of the full range of options. Only then can you properly weigh the risks and benefits of each potential therapy and weave your way through the maze of alternatives.
You deserve a pain-free life. We hope this book will help you achieve it.
—Susan S. Lang
Ithaca, New York
1
Understanding the Modern Approach
I
F YOU’RE READING THIS BOOK
, chances are you know the misery of headaches all too well. One moment life is normal, but the next your temples begin to ache and your forehead throbs. Soon your head is your worst enemy. The pounding, splitting pain of the headache overwhelms all else.
Contrary to what most people believe, you don’t have to put up with it. If you get headaches frequently, don’t despair; you can gain more control over them than you probably ever thought possible. Unfortunately, far too many people accept headaches as a fact of life. This attitude cheats you and your loved ones. Although headaches can’t necessarily be cured, they can be controlled with certain lifestyle changes and, if needed, the wise and judicious use of modern medications.
Don’t let headaches disrupt and complicate your life anymore. Take a stand. Learn what you can do to help yourself and your doctor to minimize the pain, agony, and frustration of headaches.
THE BAD NEWS
If you are one of the 45 to 50 million Americans who battle chronic headaches, you’re probably not only miserable from the pain but guilty, depressed, and frustrated about missing work, disappointing loved ones, and giving up many of life’s joys. You may fear that others view you as a malingerer, that your illness may jeopardize your job and future, and that maybe you are “crazy” and making yourself sick.
The truth is, headaches are a real physical illness and perhaps the most common medical condition plaguing human beings. They not only extort an exceedingly high price from individuals, but also from society. They are to blame for more than 157 million lost workdays a year in the United States at a price tag of some $20 billion in healthcare costs—including some 10 million office visits—and absenteeism.
The costly toll of headaches could be greatly reduced by better understanding how your lifestyle contributes to your headache pattern; how nondrug strategies, such as relaxation techniques, biofeedback, diet changes, and exercise, can make a significant impact; and how to use the right medication, chosen from a large and powerful arsenal. All you need is information, a willingness and commitment to try nondrug strategies, and in many cases, a trial-and-error approach to medication.
THE GOOD NEWS THAT FEW USE
Ironically, while a revolution has occurred in the headache field over the past ten years, most people who get headaches have failed to reap the benefits. Medical researchers understand the mechanisms of headache better than ever before. They have unlocked the mystery of how certain triggers set off headaches and how lifestyle changes can ward off many attacks. They have developed exquisitely specific headache medications that can quickly relieve or abort a potentially devastating headache. And for people who get frequent headaches, medical researchers now can provide low doses of certain medications to reduce sensitivity to headache triggers, thereby preventing many headaches from recurring.
Yet, tragically, although headache doctors now have the medical know-how to help more than 90 percent of headache sufferers, more than 70 percent of sufferers never even consult a doctor about their headaches.
WHY HEADACHES FAIL TO GET TREATED
Despite all the recent medical advances, many headache consumers passively endure the agony. Why? Because they mistakenly believe that little can be done to help them. Even worse, some people unwittingly aggravate their headaches by taking too many over-the-counter and prescription pain relievers and loading up on caffeine. Or they fail to give proven nondrug strategies, such as relaxation and other stress-reduction methods and exercise, a concerted try.
Others fail to seek medical help that could provide drugs that might change their lives. Of those who do consult doctors, many become quickly discouraged. Sometimes doctors are unaware of the latest treatments. Other times, however, consumers are given appropriate advice but are too suspicious of what may sound like a newfangled advance. Some patients think the doctor is fishing in the dark when the first medication doesn’t work and a completely different one is prescribed. Although the doctor is following a very clear and reasonable strategy that often requires trial and error, the patient who is unaware of the rationale may become confused.