Everything you Ever Wanted to Know About Chronic Headaches by Douglas Hanna - HTML preview

amounts of water are other treatments that work for some sufferers but not

for others.

In some cases, vigorous exercise has been shown to be very effective in

relieving and ending an acute attack (this produces about the same results

as the use of oxygen therapy by increasing the levels of oxygen in the body).

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8: How to Fight Chronic Daily Headaches

If you have chronic daily headaches, your treatment will have two goals; to

prevent future attacks and to relieve your headache.

Prevention includes the taking of prescribed drugs, avoiding or minimizing

the causes of your chronic daily headaches, and learning such self-help

measures as biofeedback or relaxation exercises. If your doctor suggests

prescription drugs, make sure you understand the side effects. Also, be

aware that it may take several weeks for these medications to become

effective. This means you need to be patient and cooperate with your doctor

as he or she works to help you find the best treatment.

How you are treated for these headaches will depend on which type of

headache you have - such as whether medication overuse is contributing to

your headaches. For example, if you are taking pain relievers more than two

days each week, the first step in your treatment may be to stop using these

drugs.

It is important to understand that I am not a physician nor a trained

specialist in headaches or headache relief.

The information in this chapter and throughout this book is based on

research I have done over the past several months and represents the best

information I was able to find from a variety of sources.

You should never you take any of the medications cited here

unless prescribed by your doctor after personal consultation.

Preventive Medications

There are a variety of preventive medications used to treat chronic daily

headache. Your doctor will select a drug depending on the type of chronic

daily headache you have. You should be warned that preventive drugs

typically take several weeks to build up in your system and become fully

effective. Here are the medications your doctor may recommend.

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Antidepressants

Antidepressants such as Amitriptyline (Aventyl), nortriptyline (Pamelor)

and other tricyclic antidepressants are the most widely used treatments for

all forms of chronic daily headaches. These medications are valuable because

they also help treat depression, anxiety and sleep disturbances that often

accompany chronic daily headaches.

SSRIs

There is also evidence that suggests other antidepressants such as the

selective serotonin reuptake inhibitors (SSRIs) may be effective in treating

chronic daily headaches for some sufferers.

SSRIs that have been used to treat chronic daily headaches include

fluoxetine, sertraline, paroxetine, nafazodone, veniafazine, citaloprom and

escitalopram. These SSRIs can have adverse effects so, again, it is important

you discuss these with your doctor.

The adverse side effects can include:

Loss of appetite, weight loss

Dry mouth

Irritability / anxiety

Sleeplessness and drowsiness

Increased appetite, weight gain

Allergic reactions

Shaking

Dizziness

Headache

Fits / convulsions

Disturbance of sexual function (this also may be an effect of

depression)

Sweating

Bruising

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Manic or hypomanic behavior

Abnormal movements

Low sodium level

Suicidal thoughts

Beta-blockers

While these drugs are most commonly used to treat high blood pressure,

they are often helpful in treating episodic migraines.

Beta-blockers used to treat chronic daily headache include atenolol

(Tenormin), metoprolol (Lopressor, Toprol), nadolol (Corgard), propranolol

(Inderal) and timolol (Blocadren). In some cases these beta-blockers are

prescribed in combination with antidepressants.

Anti-seizure Drugs

Anticonvulsant drugs used in migraine prevention are also being used

increasingly to treat chronic daily headache. Drugs in this category include

divalproex (Depakote), gabapentin, (Neurontin) and topiramate (Topamax).

Muscle Relaxers

While not always effective in the treatment of chronic daily headache, muscle

relaxers such as tizanidine (Zanaflex) have helped in some cases.

NSAIDs (Nonsteroidal anti-inflammatory agents)

Naproxen and other nonsteroidal and anti-inflammatory drugs may be

effective in the treatment of chronic daily headache, especially if you're

undergoing withdrawal from some other pain relievers. Included in this group

are naproxen (Aleve, Anaprox), ketoprofen (Orudis) and mefenamic acid

(Ponstel).

Cox-2 Inhibitors

While these drugs are similar to NSAIDs, they work differently and have

fewer side effects. Medications such as Celebrex, Vioxx and Excedrin are

most helpful in treating chronic daily headache when combined with other

preventive medications.

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Typically, they are prescribed for one or two months if you are withdrawing

from pain relief medications, to help decrease the frequency and severity of

rebound headaches.

Others

Botox is currently being researched as a possible treatment for many chronic

daily headaches. Injections of a local anaesthetic around a nerve (nerve

block) or injections of a numbing agent and corticosteroid at the point of pain

are sometimes recommended for chronic daily headaches.

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9. Treating Tension-type Headaches

No one has yet to discover the definitive cause of tension-type headaches

because most scientists agree that there isn't just one specific cause.

There are many causes, including:

·Inadequate rest

·Anxiety

·Fatigue

·Hunger

·Overexertion

·Poor posture

·Emotional or mental stress, including depression

Tension-type headaches are usually triggered by some internal or

environmental stress. The most common of these stresses include social

relationships, friends, work and school.

Examples of things that can trigger stress include:

·Having problems at home or a difficult family life

·A new child

·Starting a new job

·Losing a job

·Deadlines at work

·Being a perfectionist

·Being overextended

Tension-type headaches usually occur in cycles because stress of any kind

can cause muscle tension, which in turn can cause the pain, which then

causes more stress, which causes more pain.

The symptoms of tension-type headaches include:

Gradual onset

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Mild, steady or dull aching - sometimes described as a vice-like

squeezing or heavy pressure around the head

An uncomfortable feeling in the back, shoulders and neck

Stress

Anxiety

Mood swings

Difficulty falling asleep and staying asleep

Irritability

Chronic fatigue

Mild sensitivity to light and noise

General muscle aches, and

Depression.

Tension-type headaches can last from one hour to all day and can occur once

or twice a week, once a month or less.

The pain of a tension-type headache generally increases with its frequency.

In other words, the more often you experience a tension-type headache, the

more painful it will probably be.

Tension-type headaches usually come and go over a prolonged period of

time. The pain is usually throbbing and affects the front, top or sides of the

head. Although the pain may vary in intensity throughout the day, the pain is

almost always present.

There are actually two kinds of tension-type headache. They are episodic and

chronic.

Episodic Tension-type Headaches

Episodic tension-type headaches are the most common of all headaches. Of

all the adults in America, anywhere from 30% to 80% suffer from occasional

tension-type headaches.

This type headache occurs randomly, less than 15 times per month, and is

usually triggered by temporary stress, anxiety, fatigue or anger.

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They may last from 30 minutes to several days and often begin in the middle

of the day.

Chronic tension-type headaches

Chronic tension-type headache is a daily or continuous headache, which

occurs more than 15 times a month. They may vary somewhat in its pain

during a 24-hour cycle.

These headaches can also be the result of anxiety or depression. They are

often accompanied by changes in sleep patterns, early morning or late day

occurrence of headaches, feeling of guilt, weight loss, dizziness, poor

concentration, ongoing fatigue, and nausea.

Preventing Tension-type Headaches

Although there are medications available that can provide temporary relief of

tension-type headaches, the best way to combat these headaches is through

lifestyle changes.

Here are some tips that can help you in this area:

Regular Exercise.

If you perform regular aerobic exercise such as walking, swimming or biking,

you can possibly reduce the frequency and severity of your headaches. This

is because exercise relieves stress, relaxes your muscles, and increases beta-

endorphins, one of your body’s natural stress relievers -massage, stretching,

yoga and Pilates classes can also help you prevent or cut down on tension

headaches.

Managing Stress

There are other techniques such as biofeedback training and relaxation

therapy that can also help reduce stress.

Biofeedback training teaches you to control certain body responses that help

reduce pain.

There are other relaxation techniques that can help with daily headaches

such as breathing and meditation.

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There is also progressive muscle relaxation, which is done by tensing one

muscle at a time, and then completely relaxing the tension until every

muscle in your body is relaxed.

There are special classes that can teach you these relaxation techniques or

you can learn them at home using books or tapes.

It is important to understand that I am not a physician nor a trained

specialist in headaches or headache relief.

The information in this chapter and throughout this book is based on

research I have done over the past several months and represents the best

information I was able to find from a variety of sources.

You should never you take any of the medications cited here

unless prescribed by your doctor after personal consultation.

Preventive Medications

The drugs used most often to prevent tension-type headaches include

fenoprofen (Nalfon), Flurbiprofen (Ansaid), Naproxen,

Oxaprozine, Nabumetone (Relafen), and ketaprofen (Actron), and Orudis

KT.

Tricyclic Antidepressants

Anti-depressants can also be used to prevent tension-type headache. They

include amitriptyline (Elavil), Desipramine (Norpramin), imapramine

(Tofranil), Doxeprin (Sinequan), Nortryptiline (Pamelor) and protryptiline Vivactil).

Other anti-depressants used to prevent tension-type headaches may include

Prozac, Serizone, Paxil, Zoloft, Effexor, Celexa, Lexapro, Desyrel, Wellbutrin

and Phenelzine. These drugs act on tension-type headaches. They may work

at far lower doses and may also improve sleep, which is often disturbed in

headache patients.

Antidepressants such as paroxetine (Paxil), venlafaxine (Effexor) and

fluoxetine (Prozac, Sarafem) may produce fewer side-effects than tricyclic

antidepressants but generally are less reliable in preventing headaches.

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Alpha-2 adrenergic agonists, such as tizanidine are used to help prevent

tension-type headaches, as are certain opioids.

Some physicians have tried gabapentin for these headaches.

NSAIDs: NSAIDs, such as ibuprofen (Advil, Motrin IB and others) and

ketoprofen (Orudis KT) may be used to manage tension-type headaches.

Other Medications: There are other medications available that may prevent

tension headaches. They include divalproex (Depakote) and gabapentin

(Neurontin).

Muscle relaxers, such as tizanidine (Zanaflex) have also helped some

patients.

Migraine medications have also been used to prevent tension headaches,

although there are few studies available that indicate how effective they

really are.

Keep in mind that preventive medications usually require several weeks to

build up in the nervous system before having much effect. So, if you do not

see any improvements shortly after you begin taking the drug, don’t get

frustrated. It may take a couple of months or longer.

And, you may need a combination of different medications for maximum

effectiveness.

Treating Tension-type Headaches

While you may not be suffering from depression, antidepressant drugs may

be helpful in treating tension-type headaches.

In many cases, you will be able to successfully treat tension headaches with

such over-the-counter analgesics as aspirin, acetaminophen, ibuprofen,

naproxen, etc. Side effects of acetaminophen are rare but, if the drug is

taken for long periods of time and in large doses, it can cause serious liver

damage.

There are also prescription NSAIDs, such as naproxen (Naprelan, Naprosyn),

indomethacin (Indocin) and ketorolac tromethamine (Toradol).

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The side effects of these drugs include nausea, diarrhea or constipation,

abdominal or stomach pain, stomach bleeding and ulcers. These side effects

may sometimes be reduced or eliminated by taking the drugs after meals or

with milk.

It is important to understand that I am not a physician nor a trained

specialist in headaches or headache relief.

The information in this chapter and throughout this book is based on

research I have done over the past several months and represents the best

information I was able to find from a variety of sources.

You should never you take any of the medications cited here

unless prescribed by your doctor after personal consultation.

Combination medications: There are single medications that combine

aspirin or acetaminophen with caffeine or a sedative drug such as butalbital.

One example of this is Excedrin, which combines aspirin, acetaminophen and

caffeine. These combination drugs may be more effective in controlling these

headaches than pure analgesics. There are also brand-name drugs such as

Amidrine, Midrin and Migrex that are sometimes used to treat tension

headaches.

While many of these combination drugs are available over-the-counter, those

that combine aspirin or acetaminophen with a sedative are available only by

prescription.

These drugs can be addictive and can actually lead to chronic daily

headaches. This means they should not be used more than one day a week

and only with careful monitoring on the part of your doctor.

Other alternatives in the treatment of tension-type headaches are

barbiturates (butalbital), ergots (such as ergotamine or dihydroergotamine),

and anti-emetics such as prochlorperazine).

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Your doctor may also suggest muscle relaxants such as Flexeril and Soma.

(Note that these drugs do not actually relax skeletal muscles directly, but are

analgesic (pain-relieving) drugs that act on a patient's brain.)

Other drugs sometimes prescribed in the treatment of tension-type

headaches are opioids (meperidine and morphine), fenoprofen (Nalfon), and

flurbiprofen (Ansaid).

If you do have chronic tension-type headaches, you must strictly avoid habit-

forming analgesics.

You may find that biofeedback techniques can help.

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10. Alternative Treatments and Self-help Techniques

There are self-help techniques and alternative treatments that may help

lessen or even avoid many types of headaches. However, it is important to

keep in mind that none of these has been scientifically proven.

Some seem to have helped headache sufferers, others have not.

It’s up to you, under your doctor’s supervision, to try one or more of these as

this is the only way she or he can determine their effectiveness for you

personally.

In the chart below, you will find types of headaches and a list of self-help or

alternative treatments.

Go down the column for your type of headache, and then click on any

alternative or self-help treatments that interest you.

This will take you to a detailed explanation of the treatment.

This chart and its associated information are not meant to be a complete

listing of all possible treatments for headaches.

It represents some of the most popular alternate and self-help treatments.

For totally comprehensive information on alternative headache medicine, I

recommend the book “Alternative Medicine Definitive Guide – Headaches” by

Drs. Robert Milne, Blake More and Buton Goldberg, ISBN 1-88729918-1.

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Alternative Treatments Chart

Alternate

Cluster

Daily Chronic

Tension

Treatments

Migraines

Headaches

Headaches

Headaches

Oxygen Therapy

X X

Acupuncture

X X

X

X

Detoxification Therapy

X

Environmental Medicine

X

X

Ayurvedic Medicine

X

X

Naturopathy

X X

X

Ice and Heat

X

Nutrition Therapy

X

X

Massage

X

X

X

Hypnosis

X

Aromatherapy

X

X

X

Compresses and Steams

X

X