Headache Help (5 page)

By using painless electrodes on certain muscles and parts of the body, biofeedback electronically monitors body functions, such as breathing rate, blood circulation, heart rate, temperature, muscle tension, blood pressure, brain activity, and pulse. While being monitored, you practice the relaxation method of your choice and watch the instruments to see if you are actually producing physiological changes.

Temperature or thermal biofeedback can be very effective for migraines by helping you learn how to raise the temperature of your fingertips and achieve a relaxed state. The equipment lets you know how successful you are. Electromyographic biofeedback, on the other hand, which electronically monitors muscle activity, can sometimes be particularly useful for tension headaches by helping you learn how to release muscle tension.

Most pain clinics and hospitals have biofeedback equipment; however, sessions may be costly. Once you learn how to produce those physiological changes reliably, you will no longer need the machine to check you. For more information and referrals, see Appendix A.

M
ASSAGE, WARM BATHS, HOT TUBS, AND YOGA
    Combined with controlled breathing, any of these relaxation techniques may help you release tension and is worth a try to relieve mild headache pain.

Many audiotapes, available through bookstores and health magazines, can lead you through such meditations and relaxation exercises. Although not for everyone, such tapes, with their soothing background music or white noise (the sound of a night forest, for example), may help you drift into a trance, far from your painful headache. Many people feel refreshed, relaxed, and calm after listening. You may find it more useful to make your own tapes, with music and imagery you prefer.

CAFFEINE

In addition to a few moments of a relaxation exercise, you can help ward off a brewing and still somewhat mild migraine or tension headache by drinking a few cups of caffeinated tea, coffee, or a soft drink, particularly if you don’t consume a lot of caffeine on headache-free days. Caffeine may help because it constricts dilated blood vessels, which often cause the pain. Caffeine may also raise serotonin levels, according to some studies. Because it is moderately effective in warding off headaches, caffeine is an ingredient in many over-the-counter pain relievers.

The best strategy for using caffeine is either to avoid caffeine completely on headache-free days or to keep your consumption down to one or two cups a day. Then if you feel a headache beginning, have a nice strong cup or two of your favorite caffeinated drink. The beneficial effect should last several hours; if you feel the headache creeping back again, you can have another cup.

If you don’t want to have a caffeine drink, try a caffeine tablet that you can buy at the pharmacy. The rule of thumb is to take about fifty milligrams every three or four hours, as needed. Try to limit caffeine to two hundred milligrams, or, at most, three hundred milligrams per day. Your limit will depend on your sleep patterns, whether you suffer from anxiety, and if you are sensitive to rebound headaches. To see how much caffeine is present in different foods and medications, refer to the table opposite.

We can’t stress enough that caffeine (and the pain relievers you’ll read about in the next section) can also be one of your worst enemies. If you drink more than two cups of coffee or tea daily during the week but not on weekends, you’re likely to get headaches from caffeine withdrawal. These rebound headaches flare up when the effect of the caffeine wears off after your body has grown accustomed to it.

If you’re now consuming a lot of caffeine regularly, try to taper it to only one or two cups a day. Then you’ll be able to use the caffeine to your advantage.

To enhance the pain-relieving effect of caffeine, you may also want to take one of the over-the-counter pain relievers discussed in the following section.

OVER-THE-COUNTER PAIN RELIEVERS

When you’ve truly tried relaxation exercise and caffeine to no avail, an over-the-counter pain reliever may be strong enough to help, especially if it is taken during the early stages of the headache. These pain relievers are combinations or single formulations of aspirin (or acetaminophen, Tylenol’s main ingredient), with or without caffeine, and naproxen and ibuprofen, nonsteroidal anti-inflammatory drugs (NSAIDs). For the majority of people who get headaches, these medications are all they need.

But again, we must warn you about the risk of rebound headaches from taking these medications too often. Some people develop rebound headaches with as few as two or three of these pain relievers a day; others may not experience rebounds until they are consuming six or eight tablets a day. Nevertheless, it is important not to use these medications daily, but to restrict them to no more than twice a week. If you feel the need to use them more often, you should consult a doctor. Also, be sure not to mix more than one kind in the same day.

The best over-the-counter pain reliever for you will largely depend on your ability to tolerate the strongest ones. If nausea is a problem, you’re well advised to avoid products with aspirin and the nonsteroidal anti-inflammatories. The medications in the following list appear in order of effectiveness, from most to least. Keep in mind that the stronger formulations are also more likely to cause side effects, particularly stomach or gastrointestinal irritation.

THE MOST USEFUL OVER-THE-COUNTER PAIN RELIEVERS FOR HEADACHES

1. E
XCEDRIN
E
XTRA
-S
TRENGTH
, E
XCEDRIN
M
IGRAINE, OR COMPARABLE PRODUCTS
(A
NODYNOS, BC
P
OWDER, BC
T
ABLETS
, B
UFFETS II
, C
OPE
, D
URADYNE
, M
IDOL
, P
RESALIN, S-A-C
T
ABLETS
, S
ALATIN
, S
ALETO
, S
UPAC
, T
RIGESIC
, T
RI
P
AIN
, V
ANQUISH
)

Excedrin Extra-Strength and Excedrin Migraine contain acetaminophen (250 mg), aspirin (250 mg), and more caffeine (65 mg) than Anacin, which usually makes these medications more effective but also more likely to lead to caffeine rebound headaches when medication is stopped. (Excedrin Migraine has been approved by the FDA for treating mild to moderate migraines—the first over-the-counter medication to receive this approval.)

TYPICAL DOSE:
One or two tablets every three hours as needed. To prevent rebound headaches or kidney damage, use cautiously, no more than an average of two tablets a day, fourteen tablets per week, or thirty tablets a month. If more is needed, see your doctor about taking preventive medication.

S
IDE EFFECTS:
The caffeine may trigger anxiety and the aspirin may trigger nausea. Less common side effects include stom ach pain and heartburn. Long-term or high doses can cause liver or kidney problems and stomach bleeding.

2. N
APROXEN
(A
LEVE
)

Naproxen, which has been a prescription medication for many years, is now available as an over-the-counter medication. It is a very effective and nonsedating medication. Coffee or a caffeine tablet may enhance its effectiveness. The prescription versions (Anaprox, Naprosyn) contain more milligrams of naproxen and are therefore stronger.

TYPICAL DOSE
: One tablet (200 mg) with food or Turns or Rolaids. Total daily dose is three tablets, with eight to twelve hours between doses.

SIDE EFFECTS
: Nausea and stomach upset, especially among people older than forty. With long-term daily use, liver, kidney, and gastrointestinal problems are a concern.

3. I
BUPROFEN
(A
DVIL
, H
ALTRAN
, M
EDIPREN
, M
IDOL
200, M
OTRIN
, N
UPRIN
, R
UFEN
, T
RENDAR
)

An inexpensive nonsteroidal anti-inflammatory (NSAID), ibuprofen is often helpful for tension and migraine headaches and reasonably well tolerated. Adding caffeine by drinking a cup of coffee or taking a caffeine pill can make the medication even more effective.

TYPICAL DOSE
: From 200 (typical pill) to 800 mg every three to four hours as needed. Total dose should not exceed 2,400 mg per day, and if ibuprofen is used daily, blood tests should be taken to monitor potential liver or kidney irritation. Take with food or antacid.

SIDE EFFECTS
: Commonly causes gastrointestinal upset. If you need more than an average of two pills per day, your doctor will probably recommend preventive medication.

4. A
SPIRIN
-F
REE
E
XCEDRIN

Because it contains caffeine and acetaminophen only (no aspirin), it is not considered an NSAID. Without the aspirin, though, it tends to be less effective than Excedrin Extra-Strength. The lack of aspirin, however, makes it a good choice for people who tend toward ulcers, stomach upset, or excessive nausea.

TYPICAL DOSE
: One or two pills every three or four hours.

SIDE EFFECTS
: Seldom produces problems other than anxiety or insomnia from the caffeine.

5. A
SPIRIN

Aspirin is extremely helpful in many cases and more effective than acetaminophen, but it also carries a greater risk of side effects. Avoid it during pregnancy or with gastritis or ulcer disease. It is available in many forms, including buffered, or coated, tablets.

TYPICAL DOSE
: 325 to 650 mg every four hours as needed. Take with an antacid to minimize gastrointestinal irritation.

SIDE EFFECTS
: Can irritate and cause bleeding of the gastrointestinal tract, thins blood and therefore prolongs bleeding time if you cut yourself, increases likelihood of bruising if you fall or bang yourself, and can cause reversible liver damage. Kidney irritation can occur with prolonged use of high doses.

6. A
NACIN

Because it has less caffeine (32 mg) than Excedrin Extra-Strength, it is less effective but less likely to cause side effects or rebound headaches. It does contain plenty of aspirin: 400 mg in regular Anacin and 500 mg in Anacin Maximum-Strength.

TYPICAL DOSE
: One or two tablets every three to four hours as needed. Take with food or an antacid.

SIDE EFFECTS
: Because Anacin does not contain acetaminophen, it carries less risk of damage to kidneys or liver; its high level of aspirin, however, increases the risk of gastrointestinal irritation.

7. A
CETAMINOPHEN

Acetaminophen is much less effective but better tolerated than aspirin or aspirin-containing products. It can be useful, however, for milder headaches, with minimal side effects, and may be used during pregnancy, with children, and with gastritis or ulcer disease.

Available in suppositories, tablets (regular and chewable), wafers, capsules, an elixir, a liquid, and as effervescent granules with sodium bicarbonate (Bromo Seltzer).

TYPICAL DOSE
: One or two extra-strength tablets, 500 mg or 650 mg each, every three or four hours, limited to six pills per day. Do not exceed 4 g (4,000 mg) on any given day. If more than 1,500 mg is taken daily, rebound headaches may occur and preventive medication should be considered.

SIDE EFFECTS
: If used excessively (5 to 8 g per day, over weeks), acetaminophen may damage the kidneys, liver, and heart.

8. K
ETOPROFEN
(O
RUDIS
KT)

This is a low-dose (12.5 mg) anti-inflammatory; the usual dose is two to four tablets every six hours, as needed. As with the other NSAIDs, stomach (gastrointestinal) side effects are common.