Headache is a common problem
Nearly everyone knows someone who suffers with the chronic pain of headaches. This may include tension headaches that arise during stress, migraines, or cluster headaches. Tension headaches tend to follow a band-like distribution, and they are primarily frontal in location. Migraine headaches are usually one-sided, and may respond to vasoconstricting drugs that make blood vessels tighten. Cluster headaches are somewhat unique in that they can cause tearing in the eye on the side of the head affected as well as isolated congestion in that half of the nose. There are also headaches related to excessive use of medication. Medication overuse headache is thought to be the result of some repeated exposure to a rescue medication.
It is tempting to reach for a pharmacologic solution, but many headache syndromes can at least improve with lifestyle modification. Among known headache triggers are alcohol, a lack of sleep, stress, and certain foods. For the clinician, good headache management starts with taking a comprehensive history. Identifiable risk factors should be modified when possible. Patients who ingest excessive amounts of caffeine should scale back. The same goes with alcohol, especially for those who may drink red wine (which for many is a particularly strong headache trigger). The importance of sleep cannot be overstated either. While many of us can push through a hard day on little sleep, it certainly appears that sleep quality and duration make a difference in headache frequency.
Pharmacologic management of headache
Depending on the type of headache and numbness or other associated symptoms, more workup may be necessary. The patient who has significant neurologic symptoms in the setting of headache may need brain imaging to rule out an intracranial mass or process. Additionally the patient who suffers with frequent frontal headaches and has sinus complaints may need an evaluation by otolaryngology. Only after these anatomic causes of headache are ruled out, should a pharmacologic strategy be considered.
The pharmacologic management of headache involves 2 major classes of drugs: Prophylactic medications that prevent headaches from starting, and abortive medications that rescue the patient after the headache has begun. Common prophylactic medications include beta blockers, topiramate, and amitriptyline. While these may be very helpful for many patients, they also have significant side effect potential. Physicians will typically discuss these potential side effects with their patients, and this is important because the side effects can certainly influence functionality and quality of life by themselves.
Abortive medications, on the other hand, are medications only taken after the patient feels the headache coming on. These medications are designed to work quickly to relieve the pain from the headache. Other than anti-inflammatories, the most common medication in this class is the ergot derivatives. These medications cause vasoconstriction in the head which often relieves headaches especially those that are migraine. This counteracts what has been observed in the study of patients with migraine which is a local dilation of the blood vessels in the head. Of note is the risk that taking these rescue medications may increase blood pressure, and they are not recommended for patients who have suffered a previous stroke. Frequent reliance on rescue medications may in fact lead to further headache issues.
Additional management options
There are other alternative therapies some patients report to be helpful. Many patients have gotten good relief with acupuncture. Routine exercise has also been shown to be beneficial in decreasing headaches. There are other nonprescription substances that can be taken as well. Supplemental magnesium has been shown to be helpful as well as riboflavin (vitamin B2). These supplements should be tried by anybody who has frequent headaches after discussion with his or her physician. Because many of these alternative therapies have relatively benign side effects, they’re often under utilized.
If headaches are a common problem for you, take inventory of the things in your life that might be risk factors. If you seek medical advice, be sure to give your health care provider a thorough history. Often lifestyle changes will be enough to improve your headaches. If you and your physician are discussing medications to treat headache, be sure to ask about side effects and ask about non-prescription options.