Treatment

admin — Tue, 08 Nov 2011 03:53:36 +0000

Successful treatment depends on making the correct diagnosis. This section will not deal with treatment in detail for the above headache types.

For medication overuse headache, stopping medication overuse is key. Please go to the ”dealing with medication overuse” section in the detailed treatment modules on this website.

The treatment of chronic migraine is basically similar to that of migraine. For more information, see the detailed treatment modules which deal with lifestyle, specific migraine triggers, symptomatic medication, and prophylactic medication. It is also important to avoid the pitfalls of medication overuse, so see the medication overuse module.

Like migraine, chronic tension type headaches are often helped by prophylactic medications like amitriptyline and nortriptyline. Similar medications are also used for new daily persistent headache. However, the treatment of all these chronic daily headache syndromes is difficult and complicated, and requires that patients work carefully with their doctor.

Conditions

admin — Tue, 08 Nov 2011 03:52:40 +0000

Medication overuse headache: This condition happens mainly or perhaps even only in patients with migraine. Typically a person will have had migraine for many years. Over the years, the attacks gradually become more frequent. During an especially bad period, the migraine sufferer may take more and more symptomatic migraine medications (painkillers, ergotamines, or triptans), usually in an effort to meet work or family responsibilities. With this, the headaches remain frequent, and the symptomatic medication use also remains high. For some people in this situation, the headaches become daily, accompanied by daily medication use.It is easy to determine if medication overuse may be a factor in your frequent headaches. If you are taking simple painkillers like acetaminophen or non-steroidal anti-inflammatory medications like naproxen or ibuprofen more that 15 days a month, you are at risk of having medication overuse headache. Similarly, if you are taking medications containing codeine or other opiates (narcotics), ergotamines, or triptans on more than 10 days a month, you are at risk. Go to“dealing with medication overuse” on this website for more details, and discuss these issues with your doctor.
Chronic migraine: By definition, chronic migraine is a condition where a person does not have medication overuse, but still has migraine headaches on 15 days a month or more. A small proportion of people with migraine seem to progress over time from relatively infrequent headache attacks to a situation where they have headaches every day. It is unclear why this happens, and whether it can be prevented in some way.
Chronic tension type headache: These headaches are very different from migraine, in that they usually cause a constant dull pain, sometimes described like a tight band around the head. They are non-throbbing, and usually the pain affects the head equally on both sides. They are generally not as severe as migraine headaches, but they can be very persistent and become quite a nuisance. There is usually very little light or sound hypersensitivity, and very little if any nausea.This headache type usually develops in people with a history if intermittent or episodic tension type headaches. These episodic tension type headaches are often called “ordinary headaches”, by people who have them. Their symptoms are similar to chronic tension type headache, except that these episodic attacks come and go, and may last anywhere from a few hours to a few days.
New daily persistent headache: This unusual headache syndrome is diagnosed if daily headaches truly come “out of the blue”. Typically people with this headache syndrome simply get a headache one day which does not go away. The headache may last for years and be there every day from the very start. Investigations are usually normal, and no cause can be found. Occasionally, daily headaches with a similar onset can be the result of a cerebrospinal fluid leak. The cerebrospinal fluid around the brain and spinal cord is contained within a tough membrane, the dura, and is normally kept under a certain degree of pressure. Unfortunately, over 20 pairs of spinal nerves leave the spinal cord. As they travel to the rest of the body, they have to penetrate and pass through the dura membrane. At these points of penetration, people will sometimes develop a small leak so that the cerebrospinal fluid can leak out into the body tissues. This does no harm, but does lower the pressure inside the dura. Headaches from this mechanism are as a result often called low pressure headaches. These headaches do start abruptly, like new daily persistent headache. However, an important clue is that low pressure headaches usually go away quite quickly when the person lies down, and start again almost immediately when he or she stands up again.No one really knows what causes most cases of new daily persistent headache. One theory is that at least some of them are triggered by some sort of viral infection.
Hemicrania continua: This is a rare continuous headache that, as its name implies, only involves one side of the head. It usually starts as a continuous headache, and in that way is different from chronic migraine which usually has a history of previous intermittent migraine attacks. Hemicrania continua is a strange headache, in that nothing helps very much with the pain except indomethacin. Indomethacin is one of the non-steroidal anti-inflammatory drugs. Given in a high enough dose, it will usually dramatically relieve the head pain of hemicrania continua in a matter of hours or at most a day or two. Other related non-steroidal anti-inflammatory drugs may help as well, but often to a much lesser extent.

So, if you have headache on 15 days a month or more and your doctor is confident that you do not have a “secondary headache” due to a structural cause or some other serious underlying illness, then you likely have one of the above syndromes. Of course, things are not quite that simple. Some people with cluster headache will develop chronic cluster headaches. These people will also have headache every day or almost every day. The tip off here is that the cluster headache attacks are severe but short, with individual headache attacks lasting less than three hours, even though several attacks may occur during a single day. Cluster headache attacks are always one sided, and there is often associated redness and/or tearing of the eye on the side of the headache. Another possible cause of daily head pain is a problem with the upper neck and cervical spine, especially after an injury. It is controversial just how often this causes daily headache. If your doctor suspects this as a cause for your headaches because of the results of your physical examination, further tests can be done. Often, physiotherapy is a good place to start in terms of treatment.

Head injuries can also cause a daily headache syndrome.

The Headache Network » Headache on 15 days or more per month

Treatment

Conditions