Headache Help (11 page)

3. A
SPIRIN AND
C
AFFEINE
(E
XCEDRIN
E
XTRA
-S
TRENGTH
, E
XCEDRIN
M
IGRAINE
, A
NACIN
, BC H
EADACHE
P
OWDERS
, V
ANQUISH
)

Aspirin and caffeine are old standbys for migraine relief. As with the NSAIDs, though, they may trigger gastrointestinal upset. The addition of Reglan, a mild antinausea medication, may help offset nausea and increase effectiveness.

• E
  XCEDRIN
  E
  XTRA
  -S
  TRENGTH
  , E
  XCEDRIN
  M
  IGRAINE
  Excedrin is excellent for mild to moderate headaches and usually is well tolerated. This is a very effective over-the-counter medication, but it can cause anxiety, nausea, and less often, stomach pain. Its 65 mg of caffeine is more than in most OTC pain relievers, which can help to relieve pain but can occasionally lead to anxiety. The usual dose is one or two tablets every three to four hours as needed. Excedrin has proven to be one of the best medications for mild to moderate migraines.
  
• A
  SPIRIN
  -F
  REE
  E
  XCEDRIN
  Although less effective than Excedrin that contains aspirin, this OTC drug does not cause stomach irritation, making it especially useful for people with ulcers or for those who often get nauseated. This is an extremely useful preparation but not quite as effective as Excedrin Migraine.
  
• A
  NACIN
  Anacin contains slightly more aspirin (400 mg) but less caffeine (32 mg) than Excedrin. For some people, Anacin is more effective than Excedrin, and vice versa. The usual dose is one or two tablets every three to four hours, as needed; six per day at most. Stomach upset or nausea is common because of the increased amount of aspirin. The lower dose of caffeine results in less anxiety and nervousness compared to other high-caffeine compounds.
  
• BC H
  EADACHE
  P
  OWDERS
  These contain 650 mg aspirin and 32 mg caffeine along with salicylamide. Some patients do better with a powder because it may be absorbed more easily into the bloodstream. The increased amount of aspirin is helpful for headaches but can lead to more stomach upset and nausea.
  
• V
  ANQUISH
  Vanquish primarily contains aspirin, acetaminophen, and caffeine. The usual dose is one or two tablets every three to four hours as needed. As with the others, anxiety, nervousness, or stomach upset may occur.
  

4. M
IGRANAL
N
ASAL
S
PRAY

This is DHE (dihydroergotamine) nasal spray, available in pharmacies. While it is technically an ergotamine (see page 79), DHE is safer than the standard ergotamines, because it shrinks the veins more than the arteries. Since 1945, DHE has been associated with only a handful of serious side effects.

TYPICAL DOSE
: One spray in each nostril, usually repeated in ten to twenty minutes. Two sprays in each nostril in a day at most.

SIDE EFFECTS
: Stuffed nose and nausea may occur. A feeling of being hot or flushed in the head or muscle cramps occasionally occurs. While less effective than the triptans, Migranal Nasal Spray is generally a safe and well-tolerated migraine medication.

5. M
IDRIN

Midrin has held up over the years as one of the best headache medications. A combination of a blood vessel constrictor (isometheptene mucate), a mild sedative with no addiction potential (dichloralphenazone), and acetaminophen, it is extremely effective and well tolerated. It can be prescribed for children as young as five and is safe with the elderly as well.

    Although Midrin may cause fatigue, taking it with caffeine (either strong coffee or 50 to 100 mg of caffeine, as found in NoDoz) can counter this effect while at the same time enhancing the drug’s overall effectiveness.

TYPICAL DOSE
: One or two capsules when headache begins, then one capsule every hour as needed but no more than six per day or twenty per week.

    The first time you try Midrin, take only one capsule because fatigue or lightheadedness may be overwhelming with two.

    For children or others who have difficulty swallowing the large capsule, pull it apart and spread the contents in applesauce or yogurt. This method may also be used when only half a capsule is needed.

    Generic Midrin is not as effective as brand-name.

SIDE EFFECTS
: Generally well tolerated, but fatigue or mild stomach upset is common. Occasional lightheadedness. Can raise blood pressure so is used with great caution among those with high blood pressure.

6. B
UTALBITAL
C
OMPOUNDS

All these medications are potentially addicting because of the butalbital, a barbiturate sedative, but they are considered safe and effective when used sparingly. The generic forms may not be as effective as the brand names.

• F
  IORNIAL
  This drug is the most effective of the butalbital compounds because it contains aspirin instead of acetaminophen; it also contains caffeine and butalbital. Many people experience a brief high or euphoria with the medication, however, and this effect can lead to addiction. It is important not to take it, therefore, to relieve stress and anxiety.
  TYPICAL DOSE
  : One or two pills every three hours as needed, but should not be taken more than two days a week; no more than forty pills per month. Occasionally, use of one or two on a daily basis is justified.
  SIDE EFFECTS
  : Fatigue, lightheadedness, nausea, and euphoria are relatively common. Anxiety or rebound headaches occur occasionally. When taken for anxiety or stress, may lead to abuse.
  
• F
  IORINAL WITH
  C
  ODEINE
  , F
  IORICET WITH
  C
  ODEINE
  Though more effective than Fiorinal in relieving a migraine, the codeine causes more side effects. A major concern of using this medication is its potential for abuse.
  TYPICAL DOSE
  : One capsule every three hours, or two every four hours, as needed.
  SIDE EFFECTS
  : Fatigue, lightheadedness, and nausea are common. Many people can’t tolerate the codeine; stomach upset or abdominal pain are fairly common.
  
• F
  IORICET
  , E
  SGIC
  , AND E
  SGIC
  P
  LUS
  These medications are particularly useful if aspirin nauseates you because Fioricet, Esgic, and Esgic Plus contain acetaminophen instead (Esgic Plus contains additional acetaminophen). Otherwise, these drugs are similar to Fiorinal (in that they contain caffeine and butalbital). This substitution of acetaminophen for aspirin makes these medications less effective but also less troublesome, especially regarding nausea.
  TYPICAL DOSE
  : One or two pills every three hours, as needed. Each Esgic Plus pill contains 500 mg acetaminophen; no one should consume more than 4 g (4,000 mg) daily.
  SIDE EFFECTS
  : Fatigue and lightheadedness are most common; occasional nervousness; nausea is uncommon but may occur. To avoid addiction, these medications are usually not taken for daily headaches.
  
• P
  HRENILIN
  Phrenilin is similar to Esgic but has no caffeine; it contains butalbital and acetaminophen. (Phrenilin Forte contains extra acetaminophen.) Although less effective than Fiorinal or Esgic, Phrenilin is useful for people who can’t tolerate caffeine or aspirin or who take medication at night when they want to sleep. Many doctors recommend using Fiorinal or Esgic in the morning or afternoon and Phrenilin at night.
  TYPICAL DOSE
  : One or two pills every three hours, as needed.
  SIDE EFFECTS
  : Fatigue is most common because this medication has no caffeine to offset it. Occasional lightheadedness.
  

HEADACHE HELP TIP: WHEN TO GO FOR THE BRAND

Unfortunately, the generic medications for relieving headaches generally do not work as well as brand names. For ex ample, the butalbital medications, such as Fiorinal, Esgic, Fioricet, Phrenilin, Fiorinal or Fioricet with codeine, and Midrin, seem to do a better job than their generics (butalbital and duridren, respectively). The generics have to include the same ingredients, but the fillers don’t have to be the same. Sometimes the brand name is just better.

ADDICTION VERSUS DEPENDENCE

Before going on to other medications, we should point out that addiction is different from dependence.
Dependence
on a medication is an expected effect of some drugs; it means that you need the medication to reduce pain or improve the quality of your life. People who are dependent on a medication will need to take it but do not constantly increase the dose. If they stop taking the medication, they may have to reduce the dose gradually, depending upon the drug.

Addiction
, on the other hand, connotes a psychological craving for a drug. People who are addicted to a drug may constantly want to increase their dose, obsess about the medication, call the doctor’s office or clinic frequently about the medication, often with phony stories about how the medication was lost or destroyed, go to multiple doctors for the medication, or call in phony prescriptions to the pharmacy without the doctor’s consent.

The overwhelming majority of people who are prescribed pain medications do
not
become addicted. Dependence on the medicine is relatively common, but this is acceptable and to be expected with daily pain. Addiction, however, is not acceptable. Studies generally show that only one or two people out of one hundred who are prescribed pain medications actually become addicted. The reasons for addiction are many but include the fact that these medications may help anxiety and depression, and increase energy (at least for a short time). If you have an addictive personality or have had a problem with an addictive drug in the past, including alcohol, it is extremely important that you share this information with your physician. If you’ve had an addiction problem in the past, you may still use a narcotic for pain relief, but you should use narcotic medications judiciously and in very limited, controlled amounts.

SECOND-LINE MEDICATIONS FOR ABORTING MIGRAINES

If the first-line medications are not appropriate for you or have proven ineffective, a doctor may recommend one of these second-line medications.

QUICK REFERENCE GUIDE: SECOND-LINE MEDICATIONS FOR TREATING MIGRAINES IN PROGRESS

When the first-line medications aren’t appropriate or don’t work for you, your doctor may choose one of these:

1. E
   RGOTAMINES
   (C
   AFERGOT
   , E
   RGOMAR
   )
       Effective but often cause nausea, nervousness, dizziness, and sleeplessness.
   
2. K
   ETOROLAC
   I
   NJECTIONS
   (T
   ORADOL
   )
       An anti-inflammatory with no sedation or potential addiction effects; particularly good for people who tend to vomit with migraines.
   
3. C
   ORTICOSTEROIDS
   (D
   ECADRON
   , P
   REDNISONE
   , D
   EPO
   -M
   EDROL
   )
       Very effective but can only be taken for brief periods; long-term use can lead to weight gain, adrenal gland suppression, and other problems.
   
4. N
   ARCOTICS
   (
   MILD: CODEINE
   , D
   ARVON
   , V
   ICODIN
   , V
   ICOPROFEN
   , U
   LTRAM, AND
   O
   THERS; STRONG
   : S
   TADOL
   N
   ASAL
   S
   PRAY
   , D
   EMEROL
   , M
   ETHADONE
   , P
   ERCOCET
   , P
   ERCODAN
   , O
   XYCONTIN
   , T
   YLOX, AND
   M
   ORPHINE
   )
   AND
   S
   EDATIVES
   (V
   ALIUM
   , K
   LONOPIN
   )
       The narcotics should be taken with antinausea medication. Sedatives can cause sedation and drowsiness. For many patients, these drugs can help.
   
5. 5. DHE I
   NJECTIONS
       Very effective if you can give yourself injections, but nausea is common; not for people over sixty, or those with angina or poorly controlled high blood pressure.