“TREATMENT REgIMENS FoR CHRoNIC HEADACHES CoNCENTRATE oN wHAT To TAkE To PREVENT THE HEADACHE–NoT oN wHAT To TAkE FoR ACuTE PAIN.”
TreaTmenT
Both for the patients as well as the practitioners, there is no magic bullet for the treatment of Chronic Daily Headaches. For Cluster Headache Variant (Hemicrania Continua), the most effective therapy is the use of indomethacin. This drug, which is a nonsteroidal anti-inflammatory agent (NSAID), virtually cures the headache, although not without side effects. For this reason, most patients who experience a side-locked daily headache are given a brief trial of indomethacin. The remaining primary chronic headache syndromes do not have a single effective medication. It often takes months, if not years, of trial and error and a strong working relationship between the doctor and the patient to find the optimal regimen. A key conversation between the patient and the physician regarding expectations should take place early in the treatment period. It is important for both parties to understand that the headaches may never completely resolve. Appropriate goals include positive changes: fewer headaches, less severe headaches, and less disabling headaches. Lifestyle modifications should be addressed in all patients. Studies have shown that trigger avoidance, sleep, diet, exercise, and stress levels all play a role in headache frequency. Each headache sufferer is unique and therefore has unique triggers. Patients should pay attention to their own predictable provoking factors and avoid them, moving forward to help eliminate avoidable headaches It is imperative that all headache sufferers
not only get at least 8 hours of sleep but that those hours are consistent, including weekends and vacations. Additionally, chronic headache patients should maintain relatively consistent blood sugars by eating many small meals throughout the day rather than fasting and then eating a large meal, which causes a rapid and large fluctuation in blood sugar. Regular aerobic exercise should be incorporated into every headache sufferer’s day. Not only does exercise produce endorphins, which are our bodies’ natural pain killers but it helps with weight loss -- reducing the chance of obesity, a known risk factor for frequent headaches. Exercise also helps patients sleep, eliminating another trigger. Stress management, cognitive behavioral therapy, relaxation techniques, biofeedback, etc. are all useful in helping headache patients cope with the stress of daily living and should be encouraged whenever possible. There are various medications studied and shown to be effective for primary episodic migraine headache prevention, and are used traditionally for chronic headaches as well. These include: anti-seizure medications such as topiramate and valproate; blood pressure medications such as propranolol, metoprolol, and timolol; as well as, antidepressants such as amitriptyline and venlafaxine. As of now, the only medication that has FDA approval for the treatment of Chronic Migraine is onabotulinumtoxinA (Botox). In addition to prescription medications, herbal supplements, (namely magnesium), feverfew, and riboflavin (Vitamin B2) have good evidence for
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Volume 3, Issue 2 • 2013